Acquired long QT syndrome and elective anesthesia in children

Paediatric Anaesthesia
Timothy B CurryRoger D White

Abstract

We present the case of a child who had had a previous episode of torsades de pointes (TdP) and who was scheduled for elective surgery under general anesthesia. The pathophysiology of this condition and the anesthesia concerns are discussed. An 8-year-old male with a history of osteogenic sarcoma had undergone an uneventful limb salvage procedure 2 years earlier. During a subsequent admission to the hospital, he had had a cardiopulmonary arrest with complete recovery. Telemetry electrocardiogram (ECG) rhythm recordings obtained during the event showed TdP that degenerated into ventricular fibrillation, which then terminated spontaneously. On a subsequent ECG, the QTc interval was 694 ms. The prolonged QT interval was attributed to homeopathic use of cesium chloride supplements and the QT interval normalized after cesium was stopped. He presented for an elective procedure and, with an anesthetic plan that emphasized medications without known effect on the QT interval, had an uneventful perioperative course. The optimal anesthesia plan for patients with prolonged QT or those suspected to be at risk for prolongation of the QT interval has not been well described. Available evidence suggests that using total intravenous anesthesia w...Continue Reading

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Citations

Oct 7, 2008·American Journal of Physiology. Heart and Circulatory Physiology·Katja E OdeningGideon Koren
May 4, 2007·Paediatric Anaesthesia·David YatesThomas Collyer
Jul 29, 2008·Pharmacotherapy·Catherine E O'BrienCindy D Stowe
Nov 21, 2012·International Journal of Clinical Practice·P PosadzkiE Ernst
Oct 1, 2010·Paediatric Anaesthesia·Michelle C White
Jun 3, 2015·Clinical Kidney Journal·Sarah HornJohn Danziger
Sep 1, 2015·Journal of Dental Anesthesia and Pain Medicine·Kyung Jin KimTeo Jeon Shin
Sep 15, 2010·The Kaohsiung Journal of Medical Sciences·Volkan HanciIsil Ozkoçak Turan
Apr 11, 2008·European Journal of Anaesthesiology·E C S M van Woerkens, J H A M Megens
Jun 8, 2013·Anesthesia and Analgesia·Joshua JohnstonPeter Nagele

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