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Effect of Dexmedetomidine on Heart Rate-Corrected QT and T(peak)–T(end) Intervals During Robot-Assisted Laparoscopic Prostatectomy With Steep Trendelenburg Position: A Prospective, Randomized, Double-Blinded, Controlled Study

Intraperitoneal insufflation of carbon dioxide may affect the sympathetic activity that leads to changes in ventricular repolarization. This in turn can result in changes of heart rate-corrected QT (QTc) interval and Tpeak–Tend (Tp-e) interval. Dexmedetomidine is a highly selective α2-receptor agoni...

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Autores principales: Kim, Na Young, Han, Dong Woo, Koh, Jae Chul, Rha, Koon Ho, Hong, Jung Hwa, Park, Jong Min, Kim, So Yeon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902527/
https://www.ncbi.nlm.nih.gov/pubmed/27175685
http://dx.doi.org/10.1097/MD.0000000000003645
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author Kim, Na Young
Han, Dong Woo
Koh, Jae Chul
Rha, Koon Ho
Hong, Jung Hwa
Park, Jong Min
Kim, So Yeon
author_facet Kim, Na Young
Han, Dong Woo
Koh, Jae Chul
Rha, Koon Ho
Hong, Jung Hwa
Park, Jong Min
Kim, So Yeon
author_sort Kim, Na Young
collection PubMed
description Intraperitoneal insufflation of carbon dioxide may affect the sympathetic activity that leads to changes in ventricular repolarization. This in turn can result in changes of heart rate-corrected QT (QTc) interval and Tpeak–Tend (Tp-e) interval. Dexmedetomidine is a highly selective α2-receptor agonist and has potential antiarrhythmic properties. This prospective, randomized, double-blinded, controlled study evaluated the effects of dexmedetomidine administration on QTc and Tp-e intervals during robot-assisted laparoscopic prostatectomy with steep Trendelenburg position. Fifty patients scheduled for robot-assisted laparoscopic prostatectomy randomly received either a continuous infusion of dexmedetomidine at a rate of 0.3 μg/kg/hour, from anesthetic induction until the end of the Trendelenburg position (dexmedetomidine group; n = 25), or the same volume of normal saline (control group; n = 25). Anesthesia was maintained with sevoflurane and remifentanil. The primary and secondary goals were to evaluate the effect of dexmedetomidine on the QTc and Tp-e interval changes. Mean arterial pressure, heart rate, end-tidal CO(2), and end-tidal sevoflurane concentrations were assessed as well. Forty-seven patients (94%) completed the study. Dexmedetomidine significantly attenuated QTc interval prolongation and reduced the Tp-e interval, even though the baseline values of the QTc and Tp-e intervals were similar between the 2 groups (P(Group × Time) = 0.001 and 0.014, respectively). Twenty-two patients (96%) in the control group and 13 (54%) in the dexmedetomidine group had QTc interval prolongation of >20 ms from the baseline value during surgery (P = 0.001). The maximum QTc interval prolongation from the baseline value during surgery was 46 ± 21 ms in the control group and 24 ± 21 ms in the dexmedetomidine group (mean ± SD, P = 0.001). Mean arterial pressure and heart rate were comparable between the groups. Continuous infusion of dexmedetomidine at a rate of 0.3 μg/kg/hour significantly attenuated the QTc interval prolongation induced by CO(2) pneumoperitoneum with steep Trendelenburg position. Furthermore, dexmedetomidine reduced the Tp-e interval. Thus, dexmedetomidine administration may be effective for patients who are susceptible to the development of ventricular arrhythmia during robot-assisted laparoscopic prostatectomy.
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spelling pubmed-49025272016-06-27 Effect of Dexmedetomidine on Heart Rate-Corrected QT and T(peak)–T(end) Intervals During Robot-Assisted Laparoscopic Prostatectomy With Steep Trendelenburg Position: A Prospective, Randomized, Double-Blinded, Controlled Study Kim, Na Young Han, Dong Woo Koh, Jae Chul Rha, Koon Ho Hong, Jung Hwa Park, Jong Min Kim, So Yeon Medicine (Baltimore) 3300 Intraperitoneal insufflation of carbon dioxide may affect the sympathetic activity that leads to changes in ventricular repolarization. This in turn can result in changes of heart rate-corrected QT (QTc) interval and Tpeak–Tend (Tp-e) interval. Dexmedetomidine is a highly selective α2-receptor agonist and has potential antiarrhythmic properties. This prospective, randomized, double-blinded, controlled study evaluated the effects of dexmedetomidine administration on QTc and Tp-e intervals during robot-assisted laparoscopic prostatectomy with steep Trendelenburg position. Fifty patients scheduled for robot-assisted laparoscopic prostatectomy randomly received either a continuous infusion of dexmedetomidine at a rate of 0.3 μg/kg/hour, from anesthetic induction until the end of the Trendelenburg position (dexmedetomidine group; n = 25), or the same volume of normal saline (control group; n = 25). Anesthesia was maintained with sevoflurane and remifentanil. The primary and secondary goals were to evaluate the effect of dexmedetomidine on the QTc and Tp-e interval changes. Mean arterial pressure, heart rate, end-tidal CO(2), and end-tidal sevoflurane concentrations were assessed as well. Forty-seven patients (94%) completed the study. Dexmedetomidine significantly attenuated QTc interval prolongation and reduced the Tp-e interval, even though the baseline values of the QTc and Tp-e intervals were similar between the 2 groups (P(Group × Time) = 0.001 and 0.014, respectively). Twenty-two patients (96%) in the control group and 13 (54%) in the dexmedetomidine group had QTc interval prolongation of >20 ms from the baseline value during surgery (P = 0.001). The maximum QTc interval prolongation from the baseline value during surgery was 46 ± 21 ms in the control group and 24 ± 21 ms in the dexmedetomidine group (mean ± SD, P = 0.001). Mean arterial pressure and heart rate were comparable between the groups. Continuous infusion of dexmedetomidine at a rate of 0.3 μg/kg/hour significantly attenuated the QTc interval prolongation induced by CO(2) pneumoperitoneum with steep Trendelenburg position. Furthermore, dexmedetomidine reduced the Tp-e interval. Thus, dexmedetomidine administration may be effective for patients who are susceptible to the development of ventricular arrhythmia during robot-assisted laparoscopic prostatectomy. Wolters Kluwer Health 2016-05-13 /pmc/articles/PMC4902527/ /pubmed/27175685 http://dx.doi.org/10.1097/MD.0000000000003645 Text en Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 3300
Kim, Na Young
Han, Dong Woo
Koh, Jae Chul
Rha, Koon Ho
Hong, Jung Hwa
Park, Jong Min
Kim, So Yeon
Effect of Dexmedetomidine on Heart Rate-Corrected QT and T(peak)–T(end) Intervals During Robot-Assisted Laparoscopic Prostatectomy With Steep Trendelenburg Position: A Prospective, Randomized, Double-Blinded, Controlled Study
title Effect of Dexmedetomidine on Heart Rate-Corrected QT and T(peak)–T(end) Intervals During Robot-Assisted Laparoscopic Prostatectomy With Steep Trendelenburg Position: A Prospective, Randomized, Double-Blinded, Controlled Study
title_full Effect of Dexmedetomidine on Heart Rate-Corrected QT and T(peak)–T(end) Intervals During Robot-Assisted Laparoscopic Prostatectomy With Steep Trendelenburg Position: A Prospective, Randomized, Double-Blinded, Controlled Study
title_fullStr Effect of Dexmedetomidine on Heart Rate-Corrected QT and T(peak)–T(end) Intervals During Robot-Assisted Laparoscopic Prostatectomy With Steep Trendelenburg Position: A Prospective, Randomized, Double-Blinded, Controlled Study
title_full_unstemmed Effect of Dexmedetomidine on Heart Rate-Corrected QT and T(peak)–T(end) Intervals During Robot-Assisted Laparoscopic Prostatectomy With Steep Trendelenburg Position: A Prospective, Randomized, Double-Blinded, Controlled Study
title_short Effect of Dexmedetomidine on Heart Rate-Corrected QT and T(peak)–T(end) Intervals During Robot-Assisted Laparoscopic Prostatectomy With Steep Trendelenburg Position: A Prospective, Randomized, Double-Blinded, Controlled Study
title_sort effect of dexmedetomidine on heart rate-corrected qt and t(peak)–t(end) intervals during robot-assisted laparoscopic prostatectomy with steep trendelenburg position: a prospective, randomized, double-blinded, controlled study
topic 3300
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902527/
https://www.ncbi.nlm.nih.gov/pubmed/27175685
http://dx.doi.org/10.1097/MD.0000000000003645
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