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A Comparison of the Effect of Sevoflurane and Propofol on Ventricular Repolarisation After Preoperative Cefuroxime Infusion

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A Comparison of the Effect of Sevoflurane and Propofol on Ventricular Repolarisation After Preoperative Cefuroxime Infusion Hindawi BioMed Research International Volume 2019, Article ID 8978906, 6 pages https://doi.org/10.1155/2019/8978906 Research Article A Comparison of the Effect of Sevoflurane and Propofol on Ventricular Repolarisation after Preoperative Cefuroxime Infusion Yanqiu Liu,1 Hong Gao ,1 Guilong Wang ,2 Li An,1 Jing Yi,2 Xiaokui Fu,2 Chunlei Wen,2 and Zijun Wang2 1 Department of Anesthesiology, Te Afliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China 2Department of Anesthesiology, Guizhou Medical University, Guiyang, Guizhou, China Correspondence should be addressed to Hong Gao; [email protected] Received 10 July 2018; Revised 11 December 2018; Accepted 13 December 2018; Published 2 January 2019 Academic Editor: Gianluca Di Bella Copyright © 2019 Yanqiu Liu et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Te aim of this study is to investigate the changes in QT, QTc, and Tp-e intervals and Tp-e/QT ratio on surface electrocardiogram (ECG) signals during anaesthesia induction using propofol or sevofurane afer preoperative cefuroxime infusion. Some 120 cases of gynaecological patients are randomly divided into propofol (P) and sevofurane (S) groups (n=60). Afer cefuroxime (1.5 g) was infused in the two groups of patients, propofol target controlled infusion (TCI) was conducted in the P group for 5 min to realise a plasma concentration of 4 �g/ml while patients in the S group inhaled anaesthesia by infusing 1.3 MAC sevofurane for 6 min. Te 12-lead ECGs were separately collected before infusing cefuroxime (T1), afer infusing cefuroxime (T2), and afer infusing propofol or sevofurane (T3) to measure QT and Tp-e intervals, calculate QTc and Tp-e/QT, and record MAP and HR. Finally, we demonstrated that QT, QTc, and Tp-e intervals and Tp-e/QT ratio had no change (P > 0.05) afer cefuroxime infusion in the two groups of patients compared with that before infusing antibiotics. Moreover, afer conducting preoperative cefuroxime infusion, using propofol and sevofurane had no infuence on Tp-e interval, but sevofurane can signifcantly prolong QT and QTc intervals (P < 0.05). 1. Introduction sevofurane (inhalation anaesthetic) prolongs the QT interval [14]. Antibiotics and anaesthetics both have efects on QT Antibioticsarethefavouritedrugsusedtopreventandcure interval.Ithasnotbeenclarifedwhetherusingpropo- infectious diseases; however, the cardiotoxicity caused by fol or sevofurane, afer antibiotic infusion, will aggravate antibiotics cannot be ignored with the extending application abnormal ventricular repolarisation and increase TDR so in clinical practice [1–3]. It is reported that antibiotics as to increase perioperative arrhythmia. Te Tp-e interval, can prolong QT and QTc intervals [4–6]. Prolongation of the period from the peak-to-the end of the T-wave, is the QT interval increases transmural dispersion of repo- a remarkable refection of TDR in ECG and can fexibly larisation (TDR) of the ventricle, probably increasing the predict risk of arrhythmogenesis. In contrast, the ratio of risk of arrhythmia risk [5]. A case report indicates that Tp-e/QT excludes the infuence of HR [14–16]. Te study antibiotics can lead to torsade de pointes [7]. Generally, investigated the changes of QT, QTc, and Tp-e intervals and cephalosporin antibiotics are infused in surgical patients the ratio of Tp-e/QT in ECG during anaesthesia induction preoperatively to prevent postoperative wound infection by using propofol or sevofurane afer infusing cefuroxime. [8, 9]. In intraoperative periods, anaesthetic drugs also By doing so, the study evaluated the safety of patients afer infuence QT and QTc intervals [10–14]. Moreover, propo- being anaesthetised using propofol or sevofurane in view fol (intravenous anaesthetic) probably shortens, prolongs, of cardiac electrophysiology, which provides references for or does not change the QTc interval [10–12, 14] while future clinical anaesthesia. 2 BioMed Research International 2. Methods anaesthetic (assisted ventilation if necessary). During the period, SpO2 and PETCO2 were maintained at 99% to 100% Te experiment has been reviewed and approved by Medi- and 35 to 40 mmHg, respectively. cal Ethics Committee in the college (Application Number: Te QT, QTc, and Tp-e intervals and the ratio of Tp- 20150124, Guizhou Medical University), and the subjects have e/QT of the two groups of patients before infusing antibiotics given informed consent prior to participating in the study. (T1), afer infusing antibiotics (T2), and afer propofol TCI or sevofurane inhalation for specifc time (T3) were separately 2.1. Study Populations and Design. Tere were 120 cases of measured. Moreover, MAR and HR at T1 to T3 were recorded. elective gynaecological laparoscopic operation (hysteromy- omectomy, excision of ovarian cyst, and excision of ovarian 2.3. Electrocardiographic Measurements. Te ECG data were tumors) during January to November 2016 and patients aged analysed according to uniform standards afer completing from 20 to 50 showed ASA I or II. Te patients were found to the observation. According to literature [18] the V4 lead have normal preoperative cardiopulmonary function, ECG, was selected to measure the QT and Tp-e intervals. Te QT and electrolyte state, and the HR-corrected QT (QTc) interval interval was measured from the Q-wave start to the T-wave was less than 440 ms. Tey did not take medication for end while the Tp-e interval was measured from the peak-to- prolonging the QT interval including antiarrhythmic drugs, the end of the T-wave. Here, the peak of T wave refers to the blocking agent for � receptors, antidepressants, or phenoth- peak point of the T-wave and the terminal point of the T-wave iazine drugs. Moreover, they did not have diabetes or other represents the intersection point between the declined branch endocrine diseases. Te patients were randomly divided into tangent of the T-wave and the base line. If a U-wave appears, propofol (P) and sevofurane (S) groups using a random theterminalpointoftheT-waveistheincisurabetweentheT- number table, with 60 cases in each group. andU-waves[14].Treecontinuous,completeQTandTp-e intervalsweremeasuredbyusingtheV4leadtocalculatethe average value [13, 19]. According to the Bazett formula (QTc = 2.2. Procedure. Preoperative fasting and water-deprivation √�� of patients separately last for 8 h and 4 h and no patient QT/ ), the QTc and the ratio of Tp-e/QT were calculated [10]. took any preoperative medication. To prevent the infuence of diurnal change on QT interval, all of the experimental data were collected in the morning (8:30 to 11:30 A.M.) [17]. 2.4. Statistical Analysis. Statistical analysis was conducted Afer entering the operating room, the routine monitoring of byusingSPSS19.0sofware.Temeasurementdataare (�± ) MAP,HR, and SpO2 of patients was conducted. Afer opening represented by using mean and standard deviation s . the upper extremity vein (UEV), 130/0.4 sodium chloride Comparisons within group were conducted through repeated measures analysis of variance and a t-test was employed for injection (10 mL/kg) of hydroxyethyl starch (specifcation: < 500 mL/bag, batch number: 81KC081, Beijing Fresenius Kabi comparison between groups: P 0.05 denotes a statistically Medical Group) was infused to the UEV within 30 min. signifcant diference. Te ECG electrode was established and the frst ECG was obtained by using the ECG-1250C 12-lead electrocardio- 3. Results graph (Shanghai Photoelectric Medical Instrument Corpo- ration) at a chart speed of 25 mm/s and gain amplifcation (1) By comparing the two groups of patients under general of 10 mm/mV. Aferwards, cefuroxime sodium (antibiotic) conditions, it can be seen that diference is not statistically (1.5 g: batch number: 505316, specifcation: 0.75 g each, Esseti signifcant (P > 0.05), as shown in Table 1. Farmaceutici Srl, Italy) was put into 100 mL normal saline (2) By comparing the MAP and HR of the two groups and then intravenously infused within 20 min to collect the of patients at diferent time points, the diference was not second ECG. Next, the propofol (diprivan, 10 mg/mL, batch statistically signifcant (P > 0.05), as shown in Table 2. number: LC699; Corden Pharma S.P.A., Italy) TCI (Graseby (3) Te comparison of QT, QTc, and Tp-e intervals and Anaesthesia Pump 3500, UK) was applied to patients in the ratio of Tp-e/QT of the two groups of patients at diferent the P group. Te third ECG was collected afer the plasma times is summarised in Table 3. Te QT, QTc, and Tp-e concentrationreachedthetargetedlevelof4�g/mL and intervals and the ratio of Tp-e/QT of the two groups of was sustained for 5 min. Inhalation induction was conducted patients at T1 and T2 were compared and the diference was > to anaesthetise patients in the S group using sevofurane insignifcant (P 0.05). Compared with T1 and T2,theQT (batch number: 64181, specifcation: 250 mL/bottle, Maruishi and QTc intervals of the S group were prolonged at T3 (P Pharmaceutical Co., Ltd, Japan). Before induction, 8%v/v < 0.05) while the ratio of Tp-e/QT decreased (P < 0.05). of sevofurane and oxygen fow at 6 L/min was applied Compared with the P group, the QT and QTc intervals of the to prefll the breathing circuit and the oxygen fow was S group were prolonged at T3 (P < 0.05) while the ratio of adjusted to 2 L/min afer the patients fell asleep. Moreover, the Tp-e/QT decreased (P < 0.05). concentration in the volatilisation pot was adjusted and the third ECG was collected afer the sevofurane concentration 4. Discussion reached 1.3 MAC and was sustained for 6 min. During the research period, patients maintained autonomous respiration Sudden cardiac death (SCD) occurs in about 800,000 peo- and then they breathed via an oxygen mask afer using the ple every year, abnormal ventricular repolarisation-induced BioMed Research International 3 Table 1: A comparison of the two groups of patients under general conditions (mean ± SD).
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