Efecto del esmolol sobre el intervalo QT corregido y alteraciones de la dispersión del intervalo QT corregido observadas durante la inducción de la anestesia en pacientes hipertensos que recibieron un inhibidor de la enzima convertidora de la angiotensina

Zahit Çeker, Suna Akın Takmaz, Bülent Baltaci, Hülya Başar
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Abstract

Background and objectives

The importance of minimizing the exaggerated sympatho-adrenergic responses and QT interval and QT interval dispersion changes that may develop due to laryngoscopy and tracheal intubation during anesthesia induction in the hypertensive patients is clear. Esmolol decreases the hemodynamic response to laryngoscopy and intubation. However, the effect of esmolol in decreasing the prolonged QT interval and QT interval dispersion as induced by laryngoscopy and intubation is controversial. We investigated the effect of esmolol on the hemodynamic, and corrected-QT interval and corrected-QT interval dispersion changes seen during anesthesia induction in hypertensive patients using angiotensin converting enzyme inhibitors.

Methods

Sixty ASA I-II patients, with essential hypertension using angiotensin converting enzyme inhibitors were included in the study. The esmolol group received esmolol at a bolus dose of 500 mcg/kg followed by a 100 mcg/kg/min infusion which continued until the fourth minute after intubation. The control group received 0.9% saline similar to the esmolol group. The mean blood pressure, heart rate values and the electrocardiogram records were obtained as baseline values before the anesthesia, 5 min after esmolol and saline administration, 3 min after the induction, and 30 s, 2 min and 4 min after intubation.

Results

The corrected-QT interval was shorter in the esmolol group (P = .012), the corrected-QT interval dispersion interval was longer in the control group (P = .034) and the mean heart rate was higher in the control group (P = .022) 30 s after intubation. The risk of arrhythmia frequency was higher in the control group in the 4-min period following intubation (P = .038).

Conclusion

Endotracheal intubation was found to prolong corrected-QT interval and corrected-QT interval dispersion, and increase the heart rate during anesthesia induction with propofol in hypertensive patients using angiotensin converting enzyme inhibitors. These effects were prevented with esmolol (500 mcg/kg bolus, followed by 100 mcg/kg/min infusion). During induction, the blood pressure tends to decrease with esmolol where care is needed.

在接受血管紧张素转换酶抑制剂的高血压患者麻醉诱导过程中,艾司洛尔对矫正QT间期的影响和矫正QT间期分散的改变
背景与目的在高血压患者麻醉诱导过程中,减少因喉镜检查和气管插管可能导致的过度交感神经-肾上腺素能反应和QT间期及QT间期离散度变化的重要性是显而易见的。艾司洛尔降低对喉镜检查和插管的血流动力学反应。然而,艾司洛尔在减少喉镜和插管引起的QT间期延长和QT间期离散度方面的作用尚存争议。我们研究了艾司洛尔对使用血管紧张素转换酶抑制剂的高血压患者麻醉诱导过程中血流动力学、校正qt间期和校正qt间期离散度变化的影响。方法60例ASA I-II型原发性高血压患者使用血管紧张素转换酶抑制剂。艾司洛尔组给予艾司洛尔500 mcg/kg的大剂量剂量,随后持续输注100 mcg/kg/min,直至插管后4分钟。对照组给予0.9%生理盐水,与艾司洛尔组相同。取麻醉前、艾司洛尔和生理盐水给药后5 min、诱导后3 min、插管后30 s、2 min和4 min的平均血压、心率和心电图记录作为基线值。结果艾司洛尔组校正qt间期较短(P = 0.012),对照组校正qt间期离散期较长(P = 0.034),对照组插管后30s平均心率较高(P = 0.022)。对照组患者插管后4 min心律失常频率风险较高(P = 0.038)。结论使用血管紧张素转换酶抑制剂的高血压患者气管插管可延长校正qt间期和校正qt间期离散度,增加异丙酚麻醉诱导时的心率。用艾司洛尔(500微克/千克,随后100微克/千克/分钟输注)可以预防这些影响。在诱导过程中,当需要护理时,使用艾司洛尔可使血压降低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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