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Effects of esmolol on QTc interval changes during tracheal intubation: a systematic review
INTRODUCTION AND AIMS: Esmolol is an ultra-short-acting β(1) antagonist that has been shown to attenuate the corrected QT (QTc) interval prolongation associated with laryngoscopy and endotracheal intubation (LTI). Prolongation of the QTc interval can precipitate arrhythmias, the most serious of whic...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501987/ https://www.ncbi.nlm.nih.gov/pubmed/31023764 http://dx.doi.org/10.1136/bmjopen-2018-028111 |
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author | Thiruvenkatarajan, Venkatesan Lee, Jenn Yuan Sembu, Manesha Watts, Richard Van Wijk, Roelof Markus |
author_facet | Thiruvenkatarajan, Venkatesan Lee, Jenn Yuan Sembu, Manesha Watts, Richard Van Wijk, Roelof Markus |
author_sort | Thiruvenkatarajan, Venkatesan |
collection | PubMed |
description | INTRODUCTION AND AIMS: Esmolol is an ultra-short-acting β(1) antagonist that has been shown to attenuate the corrected QT (QTc) interval prolongation associated with laryngoscopy and endotracheal intubation (LTI). Prolongation of the QTc interval can precipitate arrhythmias, the most serious of which is torsades de pointes. The aim of this systematic review was to compare esmolol and placebo on QTc changes occurring during LTI. MATERIALS AND METHODS: PubMed, EMBASE, Cochrane Registry of Clinical Trials and CINAHL databases (up to August 2018) were screened for randomised controlled trials comparing esmolol and placebo on QTc changes during LTI in cardiac and non-cardiac surgeries. The primary outcome was QTc changes during LTI and secondary outcome was related to adverse effects from esmolol such as bradycardia and hypotension. RESULTS: Seven trials were identified involving 320 patients, 160 patients receiving esmolol or placebo apiece. A shortening of the QTc post-LTI was evident in the esmolol group compared with the placebo in four studies. Compared with the baseline, the QTc was reduced post-LTI in the esmolol group. In the placebo group, the QTc was prolonged compared with the baseline post LTI. Nonetheless, esmolol did not prevent QTc prolongation in the remaining three studies, and much of this was attributed to employing QTc prolonging agents for premedication and anaesthetic induction. No significant adverse events were noted. CONCLUSION: Compared with placebo, esmolol reduced the LTI-induced QTc prolongation when current non-QTc prolonging agents were chosen for tracheal intubation. Future studies should explore whether transmural dispersion (a marker of torsadogenicity) is also affected during LTI by analysing parameters such as the Tp-e interval (interval between the peak to the end of the T-wave) and Tp-e/QTc (rate corrected Tp-e interval). TRIAL REGISTRATION NUMBER: CRD42018090282. |
format | Online Article Text |
id | pubmed-6501987 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-65019872019-05-21 Effects of esmolol on QTc interval changes during tracheal intubation: a systematic review Thiruvenkatarajan, Venkatesan Lee, Jenn Yuan Sembu, Manesha Watts, Richard Van Wijk, Roelof Markus BMJ Open Anaesthesia INTRODUCTION AND AIMS: Esmolol is an ultra-short-acting β(1) antagonist that has been shown to attenuate the corrected QT (QTc) interval prolongation associated with laryngoscopy and endotracheal intubation (LTI). Prolongation of the QTc interval can precipitate arrhythmias, the most serious of which is torsades de pointes. The aim of this systematic review was to compare esmolol and placebo on QTc changes occurring during LTI. MATERIALS AND METHODS: PubMed, EMBASE, Cochrane Registry of Clinical Trials and CINAHL databases (up to August 2018) were screened for randomised controlled trials comparing esmolol and placebo on QTc changes during LTI in cardiac and non-cardiac surgeries. The primary outcome was QTc changes during LTI and secondary outcome was related to adverse effects from esmolol such as bradycardia and hypotension. RESULTS: Seven trials were identified involving 320 patients, 160 patients receiving esmolol or placebo apiece. A shortening of the QTc post-LTI was evident in the esmolol group compared with the placebo in four studies. Compared with the baseline, the QTc was reduced post-LTI in the esmolol group. In the placebo group, the QTc was prolonged compared with the baseline post LTI. Nonetheless, esmolol did not prevent QTc prolongation in the remaining three studies, and much of this was attributed to employing QTc prolonging agents for premedication and anaesthetic induction. No significant adverse events were noted. CONCLUSION: Compared with placebo, esmolol reduced the LTI-induced QTc prolongation when current non-QTc prolonging agents were chosen for tracheal intubation. Future studies should explore whether transmural dispersion (a marker of torsadogenicity) is also affected during LTI by analysing parameters such as the Tp-e interval (interval between the peak to the end of the T-wave) and Tp-e/QTc (rate corrected Tp-e interval). TRIAL REGISTRATION NUMBER: CRD42018090282. BMJ Publishing Group 2019-04-24 /pmc/articles/PMC6501987/ /pubmed/31023764 http://dx.doi.org/10.1136/bmjopen-2018-028111 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Anaesthesia Thiruvenkatarajan, Venkatesan Lee, Jenn Yuan Sembu, Manesha Watts, Richard Van Wijk, Roelof Markus Effects of esmolol on QTc interval changes during tracheal intubation: a systematic review |
title | Effects of esmolol on QTc interval changes during tracheal intubation: a systematic review |
title_full | Effects of esmolol on QTc interval changes during tracheal intubation: a systematic review |
title_fullStr | Effects of esmolol on QTc interval changes during tracheal intubation: a systematic review |
title_full_unstemmed | Effects of esmolol on QTc interval changes during tracheal intubation: a systematic review |
title_short | Effects of esmolol on QTc interval changes during tracheal intubation: a systematic review |
title_sort | effects of esmolol on qtc interval changes during tracheal intubation: a systematic review |
topic | Anaesthesia |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501987/ https://www.ncbi.nlm.nih.gov/pubmed/31023764 http://dx.doi.org/10.1136/bmjopen-2018-028111 |
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