Comparison of the Effects of Propofol and Sevoflurane on QT Interval in Pediatrics Undergoing Cochlear Implantation: A Randomized Clinical Trial Study
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Published on: September 24, 2020
Reza Safaeian1, Valiollah Hassani1, Masood Mohseni1
1Pain Research Center, Department of Anesthesiology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
Insights
For children with sensorineural hearing loss undergoing cochlear implant surgery, propofol anesthesia appears safer than sevoflurane. Sevoflurane induction was linked to increased QT interval, a cardiac risk indicator, in this patient group.
Area of Science:
- Pediatric Anesthesiology
- Cardiology
- Otolaryngology
Background:
- Children with sensorineural hearing loss (SNHL) face risks of cardiac electrophysiologic abnormalities.
- Inhalational sevoflurane anesthesia induction may prolong the QT interval in these children.
Purpose of the Study:
- To compare the electrophysiologic effects of sevoflurane versus propofol for anesthesia induction in children with SNHL undergoing cochlear implantation.
- To evaluate the safety of inhalational sevoflurane induction in this specific pediatric population.
Main Methods:
- A double-blind randomized clinical trial involving 61 children (1-18 years) candidates for cochlear implantation.
- Patients were randomized to sevoflurane (n=32) or propofol (n=29) for anesthesia induction.
- Two 12-lead ECGs were recorded pre- and post-induction to measure QTc, Tp-e interval, and JTc.
Main Results:
- Significant post-induction difference in QTc values observed between groups (sevoflurane: 445.0 ± 29 ms vs. propofol: 422.5 ± 40 ms, P=0.016).
- A greater percentage of patients in the sevoflurane group showed an increased Tp-e interval (>100 ms).
- No significant difference in long QTc (>500 ms or >60 ms increase) was found between groups post-induction.
Conclusions:
- In children with SNHL and a pre-induction QTc not exceeding 500 ms, propofol is indicated as a safer anesthetic induction agent than sevoflurane.
- Electrophysiological evaluations suggest careful consideration of anesthetic choice in SNHL patients undergoing cochlear implantation.
Background:
Children with sensorineural hearing loss are at risk of cardiac electrophysiologic abnormalities. Inhalational Sevoflurane induction in these children can cause QT prolongation.
Objectives:
In order to evaluate the safety of inhalational induction of anesthesia with sevoflurane in children with sensorineural hearing loss, who are candidates for cochlear implant, its electrophysiologic effects was compared with intravenous induction of anesthesia with propofol.
Methods:
In this double-blind randomized clinical trial, 61 children aged between one and eighteen years old, who were candidates for cochlear implantation, were randomly allocated to groups receiving anesthesia with sevoflurane (n = 32) or propofol (n = 29) for induction of anesthesia. Two 12-leads ECG were taken from all of patients before and after induction and QTc, Tp-e interval, and JTc were measured and compared.
Results:
Two cases, who had pre-induction QTc longer than 500 ms were excluded from the study. Patients had similar age (102.58 ± 87 versus 101.46 ± 67 months, P = 0.95) and gender (males: 48.3% versus 56.3%, P = 0.53) distribution. The researchers observed significant post induction difference in QTc values between these groups (propofol 422.5 ± 40, sevoflurane 445.0 ± 29, P = 0.016). There was no significant difference in the percent QTc and Tp-e changes in propofol and sevoflurane groups. Greater percentage of patients with increased Tp-e interval (> 100 ms) in the sevoflurane group than the propofol group was also seen. There was no significant long QTc difference (QTc > 500 ms or more than 60 ms increase from baseline) after induction of anesthesia in the sevoflurane group compared to the propofol group (15.6% versus 13.8%, P = 0.84).
Conclusions:
After electrophysiological evaluations in children with sensorineural hearing loss, in patients whose pre-induction QTc is not longer than 500 ms, propofol seems safer than inhalational sevoflurane for induction of anesthesia.
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