Effects of Anesthetics on Cardiac Repolarization in Adults: A Network Meta-Analysis of Randomized Clinical Trials.

IF 0.7 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Heart Surgery Forum Pub Date : 2023-12-28 DOI:10.59958/hsf.6969
Yongheng Cai, Zongping Yi, Hanwen Ou, Yong Dou, He Huang, Bing Chen
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Abstract

Objectives: Prolongation of cardiac repolarization, especially the heart rate-corrected QT (QTc) interval, is associated with life-threatening dysrhythmias. This study aimed to identify the anesthetic with the lowest risk of prolonging cardiac repolarization and provide guidance for anesthesia management in patients with cardiac diseases or long QT syndrome.

Methods: Randomized controlled trials (RCTs) comparing the effects of anesthetics on cardiac repolarization indices were searched for in multiple databases. The primary outcome was QTc; and the secondary outcomes were other repolarization indices. A network meta-analysis was conducted using a frequentist approach and registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022304970).

Results: Thirteen RCTs investigating 953 adults with normal QTc interval and without cardiovascular diseases were included. Direct meta-analyses found that propofol had less influence than sevoflurane (95% confidence interval (CI): 16.10, 33.54) and desflurane (95% CI: 4.85, 35.36), and sevoflurane had less influence than desflurane (95% CI: 6.96, 19.39) on QTc prolongation. Network analysis found that propofol had less influence than sevoflurane (95% CI: 17.78, 29.63), halothane (95% CI: 11.29, 41.24), desflurane (95% CI: 23.79, 39.88), and isoflurane (95% CI: 20.11, 46.10), and sevoflurane had less influence than desflurane (95% CI: 0.43, 15.82) on QTc prolongation. The rank order of cumulative ranking curve analysis was propofol (100%), sevoflurane (63.8%), halothane (49.5%), desflurane (21.1%), and isoflurane (15.6%). The direct meta-analysis found that propofol had less influence than sevoflurane on QT prolongation (95% CI: 23.12, 57.86). Other secondary outcomes showed no conclusive findings.

Conclusions: This meta-analysis found that propofol had a minimal effect on QTc prolongation, followed by sevoflurane and desflurane in adults with normal QTc interval and without cardiovascular diseases. Propofol is the best anesthetic for adult patients with long QT syndrome or cardiac diseases, but still needs more robust evidence.

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麻醉剂对成人心脏复极化的影响:随机临床试验的网络 Meta 分析。
目的:心脏复极化延长,尤其是心率校正QT(QTc)间期延长,与危及生命的心律失常有关。本研究旨在确定延长心脏复极化风险最低的麻醉剂,为心脏病或长 QT 综合征患者的麻醉管理提供指导:在多个数据库中搜索了比较麻醉剂对心脏复极化指数影响的随机对照试验(RCT)。主要结果为 QTc,次要结果为其他再极化指数。采用频数主义方法进行了网络荟萃分析,并在国际系统综述前瞻性注册(PROSPERO)数据库(CRD42022304970)进行了注册:结果:共纳入了13项研究,调查了953名QTc间期正常且无心血管疾病的成人。直接荟萃分析发现,丙泊酚对QTc延长的影响小于七氟醚(95% 置信区间(CI):16.10, 33.54)和地氟烷(95% CI:4.85, 35.36),七氟醚对QTc延长的影响小于地氟烷(95% CI:6.96, 19.39)。网络分析发现,丙泊酚对 QTc 延长的影响小于七氟醚(95% CI:17.78,29.63)、氟烷(95% CI:11.29,41.24)、地氟烷(95% CI:23.79,39.88)和异氟烷(95% CI:20.11,46.10),七氟醚对 QTc 延长的影响小于地氟烷(95% CI:0.43,15.82)。累积排名曲线分析的排名顺序为丙泊酚(100%)、七氟烷(63.8%)、氟烷(49.5%)、地氟烷(21.1%)和异氟烷(15.6%)。直接荟萃分析发现,异丙酚对 QT 延长的影响小于七氟醚(95% CI:23.12, 57.86)。其他次要结果没有得出结论性结论:这项荟萃分析发现,在 QTc 间期正常且无心血管疾病的成人中,丙泊酚对 QTc 延长的影响最小,其次是七氟醚和地氟醚。对于患有长 QT 综合征或心脏病的成人患者来说,丙泊酚是最好的麻醉剂,但仍需要更有力的证据。
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来源期刊
Heart Surgery Forum
Heart Surgery Forum 医学-外科
CiteScore
1.20
自引率
16.70%
发文量
130
审稿时长
6-12 weeks
期刊介绍: The Heart Surgery Forum® is an international peer-reviewed, open access journal seeking original investigative and clinical work on any subject germane to the science or practice of modern cardiac care. The HSF publishes original scientific reports, collective reviews, case reports, editorials, and letters to the editor. New manuscripts are reviewed by reviewers for originality, content, relevancy and adherence to scientific principles in a double-blind process. The HSF features a streamlined submission and peer review process with an anticipated completion time of 30 to 60 days from the date of receipt of the original manuscript. Authors are encouraged to submit full color images and video that will be included in the web version of the journal at no charge.
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