Anaesthetics and the rate corrected interval: learning from droperidol?

Current Opinion in Anaesthesiology
Edward A Shipton

Abstract

Understanding of the long QT syndrome continues to evolve. Anaesthesia in patients with untreated long QT syndrome carries a risk of perioperative malignant ventricular arrhythmias. Genotypically susceptible individuals may have a normal rate-corrected QT interval and present with torsade de pointes intraoperatively. The likelihood of arrhythmias can be reduced by careful preoperative preparation. Perioperative disturbances in physiological homeostasis and drugs administered can prolong the rate-corrected QT interval. Seven ion channel genes have been discovered and over 300 mutations identified. For acquired long QT syndrome, the main issue is the blockade of a slow component of delayed rectifier potassium ion current. Preclinical tests are recommended to assess potential new drugs for QT prolongation. Drugs not increasing the transmural dispersion of repolarization have little potential to induce arrhythmias despite prolonging the QT interval. Diagnostic DNA testing is used to screen families. Although gene-based specific therapy is preliminary, molecular genetic analysis could be useful to unravel subclinical mutations. Future therapeutic strategies include the use of sodium antagonists, potassium channel activators and prot...Continue Reading

References

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Citations

Mar 21, 2009·Clinical and Experimental Pharmacology & Physiology·Radoslaw OwczukMaria Wujtewicz
May 29, 2012·Journal of the Chinese Medical Association : JCMA·Yi-Min KuoKuang-Yi Chang

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