Intraoperative Change in QTc in a Patient with a Prolonged QTc Interval

YAMAMOTO Takeshi, TAKAISHI Kazumi, OTSUKA Ryo, FUJIWARA Shigeki, EGUCHI Satoru, KITAHATA Hiroshi

doi:10.24569/jjdsa.47.2_53

<p> Long QT syndrome is characterized by a prolongation of the QT interval and a morphological change in the T wave on an electrocardiogram. Prolongation of the QT interval is associated with serious arrhythmia and may cause syncope and sudden death. A 13-year-old male with a prolonged corrected QT interval (QTc) on a preoperative electrocardiogram was scheduled to undergo the extractation of a supernumerary tooth under general anesthesia.</p><p> Although he had no remarkable past medical history, his QTc was prolonged to 514 ms on a 12-lead electrocardiogram. There was no history of syncope or sudden death in his family. The QTc at the time of his entrance into the operation room was 483 ms. During surgery, his QTc was continuously monitored in addition to the usual intraoperative monitoring. After the rapid introduction of anesthesia with remifentanil and propofol, the anesthesia was maintained with remifentanil and sevoflurane in oxygen and air. No significant change in the QTc was observed at the time of tracheal intubation accompanied by sympathetic stimulation. There was also no significant change in the QTc after the administration of atropine for bradycardia. However, when 2% lidocaine containing adrenaline was used for local anesthesia, the QTc gradually became prolonged reaching a maximum of 507 ms. In patients with a prolonged QT interval on a preoperative electrocardiogram, careful attention may be needed during the use of local anesthetics containing adrenaline. In addition, continuous monitoring of the QTc during surgery may be useful for the prevention of serious arrhythmias.</p>

Intraoperative Change in QTc in a Patient with a Prolonged QTc Interval

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