Archives of Anesthesiology and Critical Care 2015. 1(4):107-111.

The Effect of Intravenous Lidocaine on QTc Changes During Spinal Anesthesia in Elderly Patients
Mahmood Akhlaghi, Hamidreza Azizi Farsani, Gholamreza Shabanian, Mohammad Ardeshiri

Abstract


Background: Prolonged QT interval may lead to serious arrhythmias and ventricular fibrillation, hence prevention of the QT-interval prolongation is crucial for physicians. The aim of this study was to assess the influence of intravenous lidocaine on the QTc interval resulting from spinal anesthesia with bupivacaine.

Methods: In a randomized double blind trial, fifty male patients with mean age of 70.38 and ASA physical status ΙΙ, who underwent spinal anesthesia for elective orthopedic lower limb surgical procedures, were assessed. Our subjects were divided into two groups, patients randomly received intravenously either 1.5 mg/kg lidocaine 2% as test group (n=25), or 0.05 ml/kg isotonic sodium chloride as control group (n=25), just before inducing of spinal anesthesia. Spinal anesthesia was performed in the sitting position with 3 ml of 0.5% hyperbaric bupivacaine. Values of the QTc interval, heart rate, and arterial blood pressure were measured before spinal anesthesia as well as 1, 5, 15, and 30 minutes after spinal anesthesia.

Results: With respect to the within-group values, statistically significant prolongation of the QTc interval as well as hemodynamic variability were detected in the measured times after blockade. There was no statistical difference between two groups according to hemodynamic parameters and the duration of the QTc interval before spinal anesthesia and times after spinal block with bupivacaine.

Conclusion: Administration of intravenous lidocaine may not prevent the prolongation of the QTc interval and hemodynamic changes resulting from spinal anesthesia with hyperbaric bupivacaine, in elderly subjects.


Keywords


spinal anesthesia; QT interval; bupivacaine

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References


Owczuk R, Wujtewicz MA, Sawicka W, Piankowski A, Polak-Krzeminska A, Morzuch E, et al. The effect of intravenous lidocaine on QT changes during tracheal intubation. Anaesthesia 2008; 63(9):924-31.

Shah RR. The significance of QT interval in drug development. Br J Clin Pharmacol. 2002; 54(2): 188–202.

Owczuk R, Sawicka W, Wujtewicz MA, Kawecka A, Lasek J, Wujtewicz M. Influence of spinal anesthesia on corrected QT interval. Reg Anesth Pain Med. 2005; 30(6):548-52.

Khan IA. Clinical and therapeutic aspects of congenital and acquired long QT syndrome. Am J Med. 2002; 112(1):58-66.

Gori F, Pasqualucci A, Corradetti F, Milli M, Peduto V. Maternal and neonatal outcome after cesarean section: the impact of anesthesia. J Matern Fetal Neonatal Med. 2007; 20(1):53-7.

Wee M, Brown H, Reynolds F. The National Institute of Clinical Excellence (NICE) guidelines for caesarean sections: implications for the anaesthetist. Int J Obstet Anesth. 2005; 14(2):147-58.

Deniz Y, Okyay D, Hancı V, Yurtlu S, Ayoğlu H, Özkocak Turan I. The Effect of Levobupivacaine and Bupivacaine on QT, Corrected QT (Qtc), and P Wave Dispersions in Cesarean Section. Braz J Anesthesiol. 2013; 63(2):202-8.

Asfar S, Abdulla W. The effect of various administration routes of lidocaine on hemodynamics and ECG rhythm during endotracheal intubation. Acta Anaesthesiol Belg. 1990; 41(1):17-24.

Panoulas VF, Toms TE, Douglas KM, Sandoo A, Metsios GS, Stavropoulos-Kalinoglou A, et al. Prolonged QTc interval predicts all-cause mortality in patients with rheumatoid arthritis: an association driven by high inflammatory burden. Rheumatology 2014; 53(1):131-7.

Rich JD, Thenappan T, Freed B, Patel AR, Thisted RA, Childers R, et al. QTc prolongation is associated with impaired right ventricular function and predicts mortality in pulmonary hypertension. Int J Cardiol. 2013; 167(3):669-76.

Marafioti V, Rossi A, Carbone V, Pasqualin A, Vassanelli C. Prolonged QTc interval is a powerful predictor of non-cardiac mortality in patients with aneurysmal subarachnoid hemorrhage independently of traditional risk factors. Int J Cardiol. 2013; 170(1):e5-6.

Kim YH, Lee JH, Hong CK, Cho KW, Park YH, Kim YW, et al. Heart rate-corrected QT interval predicts mortality in glyphosate-surfactant herbicide-poisoned patients. Am J Emerg Med. 2014; 32(3):203-7.

Noseworthy PA, Peloso GM, Hwang SJ, Larson MG, Levy D, O'Donnell CJ, et al. QT interval and long-term mortality risk in the Framingham Heart Study. Ann Noninvasive Electrocardiol. 2012; 17(4):340-8.

Sen S, Ozmert G, Turan H, Caliskan E, Onbasili A, Kaya D. The effects of spinal anesthesia on QT interval in preeclamptic patients. Anesth Analg. 2006; 103(5):1250-5.

Hanci V, Yurtlu S, Karabag T, Okyay D, Hakimoglu S, Kayhan G, et al. Effects of esmolol, lidocaine and fentanyl on P wave dispersion, QT, QTc intervals and hemodynamic responses to endotracheal intubation during propofol induction: a comparative study. Braz J Anesthesiol. 2013; 63(3):235-44.

Khan IA, Gowda RM. Novel therapeutics for treatment of long-QT syndrome and torsade de pointes. Int J Cardiol. 2004; 95(1):1-6.

Newman D. Overview of lidocaine. Cardiac Electrophysiology Review. 2000;4:248-50.

Ugur B, Yuksel H, Odabasi AR, Ogurlu M, Onbasili A, Aydin ON. Effects of intravenous lidocaine on QTd and HRV changes due to tracheal intubation during sevoflurane induction. Int Heart J. 2006; 47(4):597-606.

Liu SS, McDonald SB. Current issues in spinal anesthesia. Anesthesiology. 2001; 94(5):888-906.

Chamberlain DP, Chamberlain BD. Changes in the skin temperature of the trunk and their relationship to sympathetic blockade during spinal anesthesia. Anesthesiology. 1986; 65(2):139-43.

Pollard JB. Cardiac arrest during spinal anesthesia: common mechanisms and strategies for prevention. Anesth Analg. 2001; 92(1):252-6.


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