The Clinical Significance of QT Interval Prolongation in Anesthesia and Pain Management: What You Should and Should Not Worry About

Pain Medicine (United States)

Volumn 13, Issue 8, 2012, Pages 1072-1080

  Spevak, Christopher ^a,c   Hamsher, Carlyle ^c   Brown, Carlton Q ^b   Wedam, Erich F ^a,b   Haigney, Mark C ^a,b  

^a UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES   (United States)

^b WALTER REED ARMY MEDICAL CENTER   (United States)

^c GEORGETOWN UNIVERSITY MEDICAL CENTER   (United States)

Author keywords

Acute pain; Anesthesiology; Methadone; QT interval

Indexed keywords

DROPERIDOL; ELECTROLYTE; METHADONE; SEVOFLURANE; THIORIDAZINE;

ANALGESIA; ANESTHESIA; ARTICLE; CHOLINERGIC SYSTEM; ELECTROCARDIOGRAM; HEART ATRIUM PACING; HEART MUSCLE POTENTIAL; HEART RATE; HUMAN; HYPERCAPNIA; HYPOXIA; OUTPATIENT; PERIOPERATIVE PERIOD; QT INTERVAL; QT PROLONGATION; RISK FACTOR; TORSADE DES POINTES;

EID: 84865302605     PISSN: 15262375     EISSN: 15264637     Source Type: Journal    
DOI: 10.1111/j.1526-4637.2012.01406.x     Document Type: Article

References (57)

1. Nuttall GA, Eckerman KM, Jacob KA, etal. Does low-dose droperidol administration increase the risk of drug-induced QT prolongation and torsade de pointes in the general surgical population? Anesthesiology 2007;107:531-6.
2. Monahan BP, Ferguson CL, Killeavy ES, etal. Torsades de pointes occurring in association with terfenadine use. JAMA 1990;264(21):2788-90.
3. Roden DM. Drug-induced prolongation of the QT interval. N Engl J Med 2004;350:1013-22.
4. Banai S, Tzivoni D. Drug therapy for torsade de pointes. J Cardiovasc Electrophysiol 1993;4(2):6-11.
5. Huang MH, Hull SS Jr, Foreman RD, Lazzara R, Wolf S. Heart rate-QT relationships during baroreceptor stimulation with diminished autonomic influence on the ventricles. Integr Physiol Behav Sci 1992;27(1):6-12.
6. Ks to canine ventricular repolarization: Key role for β-adrenergic receptor stimulation. Circulation 2003;107(21):2753-60.
7. Roden DM, Yang T. Protecting the heart against arrhythmias: Potassium current physiology and repolarization reserve. Circulation 2005;112(110):1376-8.
8. Greenberg MI. Drug manufacturers' warning could be construed as standard of care. Emerg Med News 2002;24(11):26.
9. Fischler M, Bonnet F, Trang H, etal. The pharmacokinetics of droperidol in anesthetized patients. Anesthesiology 1986;64:486-9.
10. Bailey P, Norton R, Karan S. The FDA droperidol warning: Is it justified? Anesthesiology 2002;97(1):288-9.
11. White PF, Song D, Abrao J, Klein KW, Navarette B. Effect of low-dose droperidol on the QT interval during and after general anesthesia. Anesthesiology 2005;102:1101-5.
12. Kongsamut S, Kang J, Chen XL, Roehr J, Rampe D. A comparison of the receptor binding and HERG channel affinities for a series of antipsychotic drugs. Eur J Pharmacol 2002;450:37-41.
13. Ray WA, Chung CP, Murray KT, Hall K, Stein CM. Atypical antipsychotic drugs and the risk of sudden cardiac death. N Engl J Med 2009;360(3):225-35.
14. Han DW, Park K, Jang SB, Kern SE. Modeling the effect of sevoflurane on corrected QTc prolongation. Anesthesiology 2010;113:806-11.
15. Mason JW, Ramseth DJ, Chanter DO, etal. Electrocardiographic reference ranges derived from 79, 743 ambulatory subjects. J Electrocardiol 2007;40(3):228-34.
16. Kim HS, Kim JT, Kim CS, etal. Effects of sevoflurane on QT parameters in children with congenital sensorineural hearing loss. Anaesthesia 2009;64(1):3-8.
17. Diedrich A, Jordan J, Shannon JR, Robertson D, Biaggioni I. Modulation of QT interval during autonomic nervous system blockade in humans. Circulation 2002;106(17):2238-43.
18. Saussine M, Massad I, Raczka F, Davy JM, Frapier JM. Torsade de pointes during sevoflurane anesthesia in a child with congenital long QT syndrome. Paediatr Anaesth 2006;16(1):63-5.
19. Thiruvenkatarajan V, Osborn KD, Van Wijk RM, etal. Torsade de pointes in a patient with acute prolonged QT syndrome and poorly controlled diabetes during sevoflurane anaesthesia. Anaesth Intensive Care 2010;38(3):555-9.
20. Abe K, Takada K, Yoshiya I. Intraoperative torsade de pointes ventricular tachycardia and ventricular fibrillation during sevoflurane administration. Anesth Analg 1998;86:701-2.
21. Yamada M, Hatakeyama N, Malykhina AP, etal. The effects of sevoflurane and propofol on QT interval and heterologously expressed human ether-a-go-go related gene currents in Xenopus oocytes. Anesth Analg 2006;102(1):98-103.
22. Furushima H, Niwano S, Chinushi M, etal. Effect of atropine on QT prolongation and torsade de pointes induced by intracoronary acetylcholine in the long QT syndrome. Am J Cardiol 1999;83:714-8.
23. Farkas A, Dempster J, Coker SJ. Importance of vagally mediated bradycardia for the induction of torsade de pointes in an in vivo model. Br J Pharmacol 2008;154:958-70.
24. El-Sherif N, Bekheit SS, Henkin R. Quinidine-induced long QTU interval and torsade de pointes: Role of bradycardia-dependent early afterdepolarizations. J Am Coll Cardiol 1989;14(1):252-7.
25. Selyanko AA, Hadley JK, Wood IC, etal. Inhibition of KCNQ1-4 potassium channels expressed in mammalian cells via M1 muscarinic acetylcholine receptors. J Physiol 2000;522(Pt 3):349-55.
26. Warner M, Chen LH, Makuc DM. Increase in fatal poisonings involving opioid analgesics in the United States, 1999-2006. NCHS Data Brief 2009;(22):1-8.
27. Paulozzi LJ, Ryan GW. Opioid analgesics and rates of fatal drug poisoning in the United States. Am J Prev Med 2006;31(6):506-11.
28. Chugh SS, Socoteanu C, Reinier K, etal. A community-based evaluation of sudden death associated with therapeutic levels of methadone. Am J Med 2008;121(1):66-71.
29. Brown R, Kraus C, Fleming M, Reddy S. Methadone: Applied pharmacology and use as adjunctive treatment in chronic pain. Postgrad Med J 2004;80(949):654-9.
30. Callahan RJ, Au JD, Paul M, Liu C, Yost CS. Functional inhibition by methadone of N-methyl-D-aspartate receptors expressed in Xenopus oocytes: Stereospecific and subunit effects. Anesth Analg 2004;98:653-9.
31. Katchman AN, McGroary KA, Kilborn MJ, etal. Influence of opioid agonists on cardiac human ether-a-go-go related gene K+ currents. J Pharmacol Exp Ther 2002;303:688-94.
32. Wedam EF, Bigelow GE, Johnson RE, Nuzzo PA, Haigney MC. QT interval effects of methadone, levomethadyl, and buprenorphine in a randomized trial. Arch Intern Med 2007;167(22):2469-75.
33. Krantz MJ, Lewkowiez L, Hays H, etal. Torsade de pointes associated with very-high-dose methadone. Ann Intern Med 2002;137:501-4.
34. Pearson EC, Woosley RL. QT prolongation and torsade de pointes among methadone users: Reports to the FDA spontaneous reporting system. Pharmacoepidemiol Drug Saf 2005;14:747-53.
35. Patel AM, Singh JP, Ruskin JN. Role of implantable cardioverter-defibrillators in patients with methadone-induce long QT syndrome. Am J Cardiol 2008;101(2):209-11.
36. Hanon S, Seewald RM, Yang F, Schweitzer P, Rosman J. Ventricular arrhythmias in patients treated with methadone for opioid dependence. J Interv Card Electrophysiol 2010;28:19-22.
37. Wang D, Teichtahl H, Drummer O, etal. Central sleep apnea in stable methadone maintenance treatment patients. Chest 2005;128:1348-56.
38. Gillis AM, Stoohs R, Guilleminault C. Changes in the QT interval during obstructive sleep apnea. Sleep 1991;14(4):346-50.
39. Monahan K, Storfer-Isser A, Mehra R, etal. Triggering of nocturnal arrhythmias by sleep-disordered breathing events. J Am Coll Cardiol 2009;54(19):1797-804.
40. Schwartz PJ, Priori SG, Spazzolini C, etal. Genotype-phenotype correlation in the long-QT syndrome: Gene-specific triggers for life-threatening arrhythmias. Circulation 2001;103(1):89-95.
41. Ernst E, Bartu A, Popescu A, etal. Methadone-related deaths in Western Australia 1993-99. Aust N Z J Public Health 2002;26(4):364-70.
42. Lintzeris N, Mitchell TB, Bond AJ, Nestor L, Strang J. Pharmacodynamics of diazepam co-administered with methadone or buprenorphine under high dose conditions in opioid dependent patients. Drug Alcohol Depend 2007;91:187-94.
43. Kuryshev YA, Bruening-Wright A, Brown AM, Kirsch GE. Increased cardiac risk in concomitant methadone and diazepam treatment: Pharmacodynamic interactions in cardiac ion channels. J Cardiovasc Pharmacol 2010;56:420-30.
44. Justo D, Gal-Oz A, Paran Y, Goldin Y, Zeltser D. Methadone-associated torsade de pointes (polymorphic ventricular tachycardia) in opioid-dependent patients. Addiction 2006;101:1333-8.
45. Betapace. Available at: http://www.drugs.com/pro/betapace.html#i4i_warnings_id_c6cb84ec-20d9-4b16-ad63-92a417564d0e (accessed May 27, 2012).
46. Pedersen HS, Elming H, Seibaek M, etal. Risk factors and predictors of torsade de pointes ventricular tachycardia in patients with left ventricular systolic dysfunction receiving Dofetilide. Am J Cardiol 2007;100(5):876-80.
47. Krantz MJ, Martin J, Stimmel B, Mehta D, Haigney MCQ. Tc interval screening in methadone treatment. Ann Intern Med 2009;150(6):387-95.
48. Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia. Pain Physician 2011;14(2):145-61.
49. Sjøgren P, Jensen NH, Jensen TS. Disappearance of morphine induced hyperalgesia after discontinuing or substituting morphine with other opioid agonists. Pain 1994;59:313-6.
50. Sjøgren P, Thunedborg LP, Christrup L, Hansen SH, Franks J. Is development of hyperalgesia, allodynia and myoclonus related to morphine metabolism during long-term administration? Six case histories. Acta Anaesthesiol Scand 1998;42:1070-5.
51. Lawlor P, Walker P, Bruera E, Mitchell S. Severe opioid toxicity and somatization of psychosocial distress in a cancer patient with a background of chemical dependence. J Pain Symptom Manage 1997;13:356-61.
52. Mercadante S, Arcuri E. Hyperalgesia and opioid switching. Am J Hosp Palliat Care 2005;22:291-4.
53. Axelrod DJ, Reville B. Using methadone to treat opioid-induced hyperalgesia and refractory pain. J Opioid Manag 2007;3:113-4.
54. Kharasch ED. Intraoperative methadone: Rediscovery, reappraisal, and reinvigoration? Anesth Analg 2011;112(1):13-6.
55. Kornick CA, Kilborn MJ, Santiago-Palma J, etal. QTc interval prolongation associated with intravenous methadone. Pain 2003;105(3):499-506.
56. Pickham D, Helfenbein E, Shinn JA, etal. High prevalence of corrected QT interval prolongation in acutely ill patients is associated with mortality: Results of the QT in practice (QTIP) study. Crit Care Med 2012;40(2):394-9.
57. Horn JR, Hansten PD. Get to Know an Enzyme: CYP3A4. Available at: http://www.pharmacytimes.com/publications/issue/2008/2008-09/2008-09-8687 (accessed 10 April 2012).