Effects of Anesthetics on Cardiac Repolarization in Adults: A Network Meta-Analysis of Randomized Clinical Trials

作者全名："Cai, Yongheng; Yi, Zongping; Ou, Hanwen; Dou, Yong; Huang, He; Chen, Bing"

作者地址："[Cai, Yongheng; Yi, Zongping; Ou, Hanwen; Dou, Yong; Huang, He; Chen, Bing] Chongqing Med Univ, Affiliated Hosp 2, Dept Anesthesia, Chongqing 400000, Peoples R China"

通信作者："Chen, B (通讯作者)，Chongqing Med Univ, Affiliated Hosp 2, Dept Anesthesia, Chongqing 400000, Peoples R China."

来源：HEART SURGERY FORUM

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001167625100027

JCR分区：Q4

影响因子：0.7

年份：2023

卷号：26

期号：6

开始页：E905

结束页：E916

文献类型：Review

关键词：anesthetics; arrhythmia; network meta-analysis; long QT; syndrome; propofol

摘要："Objectives: Prolongation of cardiac repolarization, especially the heart rate-corrected QT (QTc) interval, is associated with life-threatening dysrhythmias. This study aimed to identify the anesthetic with the lowest risk of prolonging cardiac repolarization and provide guidance for anesthesia management in patients with cardiac diseases or long QT syndrome. Methods: Randomized controlled trials (RCTs) comparing the effects of anesthetics on cardiac repolarization indices were searched for in multiple databases. The primary outcome was QTc; and the secondary outcomes were other repolarization indices. A network meta-analysis was conducted using a frequentist approach and registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022304970). Results: Thirteen RCTs investigating 953 adults with normal QTc interval and without cardiovascular diseases were included. Direct meta-analyses found that propofol had less influence than sevoflurane (95% confidence interval (CI): 16.10, 33.54) and desflurane (95% CI: 4.85, 35.36), and sevoflurane had less influence than desflurane (95% CI: 6.96, 19.39) on QTc prolongation. Network analysis found that propofol had less influence than sevoflurane (95% CI: 17.78, 29.63), halothane (95% CI: 11.29, 41.24), desflurane (95% CI: 23.79, 39.88), and isoflurane (95% CI: 20.11, 46.10), and sevoflurane had less influence than desflurane (95% CI: 0.43, 15.82) on QTc prolongation. The rank order of cumulative ranking curve analysis was propofol (100%), sevoflurane (63.8%), halothane (49.5%), desflurane (21.1%), and isoflurane (15.6%). The direct metaanalysis found that propofol had less influence than sevoflurane on QT prolongation (95% CI: 23.12, 57.86). Other secondary outcomes showed no conclusive findings. Conclusions: This meta-analysis found that propofol had a minimal effect on QTc prolongation, followed by sevoflurane and desflurane in adults with normal QTc interval and without cardiovascular diseases. Propofol is the best anesthetic for adult patients with long QT syndrome or cardiac diseases, but still needs more robust evidence."

基金机构：Kuanren Talents Program of the Second Affiliated Hospital of Chongqing Medical University [[2021]24]; Young and Middle-aged Outstanding Medical Team of Chongqing

基金资助正文：This work is supported by Grant [2021]24 from the Kuanren Talents Program of the Second Affiliated Hospital of Chongqing Medical University and the Young and Middle-aged Outstanding Medical Team of Chongqing.