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ORIGINAL ARTICLE Table of Contents   
Year : 2009  |  Volume : 12  |  Issue : 2  |  Page : 107-112
A comparison of the effects of desflurane, sevoflurane and propofol on QT, QTc, and P dispersion on ECG


1 Turkey Yuksek Ihtisas Hospital Anaestesiology and Reanimation Clinic, Turkey
2 Ankara Atatürk Education and Research Hospital Anaestesiology and Reanimation Clinic, Turkey
3 Gaziantep Universty Hospital Anaestesiology and Reanimation Clinic, Turkey
4 Sivas Cumhuriyet Universty Cardiology Clinic, Turkey

Click here for correspondence address and email

Date of Web Publication21-Jul-2009
 

   Abstract 

The aim of this prospective, randomized, and double-blinded study was to compare the effects of desflurane, sevoflurane, propofol on both atrial and ventricular wall function by measurement of QT dispersion (QTd), corrected QT dispersion (QTcd), and P dispersion (Pd) on electrocardiogram (ECG). Forty-six patients from the American Society of Anesthesiologists class I−II undergoing noncardiac surgery, were enrolled in this study. Patients were randomly allocated to receive desflurane, sevoflurane or propofol anesthesia. ECG recordings were taken before and after 5 minutes of drug administration. Induction with desflurane significantly increased the QTd compared to baseline (38 ± 2 ms vs. 62 ± 6 ms, P < 0.05). Sevoflurane and propofol anesthesia was not associated with any changes in QTd. QTcd was increased with desflurane induction and decreased with sevoflurane and propofol induction, but this decrease was only significant in the propofol group (67 ± 5 ms vs. 45 ± 3 ms, P < 0.05). Pd was significantly increased after induction with desflurane (34 ± 3 vs. 63 ± 6 ms, P < 0.05). There was a significant increase in QTd and Pd in desflurane group, but this increment did not cause any dangerous arrhythmias. QTcd significantly decreased in propofol group. We believe that further investigations are required for using desflurane as safe as sevoflurane and propofol in noncardiac surgery patients who have high cardiac arrhythmia and ischemia risk.

Keywords: Sevoflurane, desflurane, propofol, QTdispersion, QTc dispersion, P dispersion

How to cite this article:
Kazanci D, Unver S, Karadeniz U, Iyican D, Koruk S, Yilmaz M B, Erdemli O. A comparison of the effects of desflurane, sevoflurane and propofol on QT, QTc, and P dispersion on ECG. Ann Card Anaesth 2009;12:107-12

How to cite this URL:
Kazanci D, Unver S, Karadeniz U, Iyican D, Koruk S, Yilmaz M B, Erdemli O. A comparison of the effects of desflurane, sevoflurane and propofol on QT, QTc, and P dispersion on ECG. Ann Card Anaesth [serial online] 2009 [cited 2018 Jan 23];12:107-12. Available from: http://www.annals.in/text.asp?2009/12/2/107/51361



   Introduction Top


The QT interval is measured from the beginning of the QRS complex to the end of T wave and represents the total duration of ventricular systole including myocardial depolarization and repolarization; measuring the QT interval is difficult. The QT interval is affected by autonomic tone, heart rate, catecholamines, gender. [1],[2],[3],[4] A variety of corrected QT (QTc) derived electrocardiography (ECG) indices may be analyzed to evaluate the effect of a drug on ventricular repolarization and the potential clinical risk of torsade de pointes (TdP). QT dispersion (QTd) is one of them. QTc is calculated with Bazett's formula (QTc = QT/√RR sec). QTc dispersion (QTcd) is defined as the difference between the maximum and the minimum QT interval;[5] QTd may supplement more standard analyses of QT/QTc interval duration. Numerous studies have identified QTd as a predictor of both types of life-threatening arrhythmias, i.e., substantial amounts of viable myocardium in the infarct region and cardiovascular mortality. [5],[6] Also, QTd might have potential utility in the assessment of drug-induced proarrhythmias risk. [5] Sevoflurane, isoflurane, and desflurane have been reported to prolong QTd, QTc, and QTcd. [7] According to Tanskanen et al ., propofol increased the QTd greater than thiopental in the patients with subarachnoid hemorrhage, but the incidence of cardiac dysrhythmias was similar in the study groups. [1]

Although, many aspects of anesthetic agent-related ventricular arrhythmia have been studied; atrial arrhythmia, a potentially serious complication has not been investigated. P-wave dispersion (Pd) has been defined as the difference between the maximum and the minimum P-wave duration related to nonhomogeneous and discontinuous propagation of sinus impulses through the atrial wall. Prolonged P-wave duration and increased Pd are associated with increased risk of atrial fibrillation. [8],[9]

Effects of coadministered several anesthetics on QTd were studied after induction and intubation, but these do not represent individual drug effects. [1],[2],[7] Therefore, the aim of this study was to investigate individual effects of sevoflurane, propofol, and desflurane on both atrial and ventricular wall by measurement of QTd and Pd.


   Materials and Methods Top


After obtaining approval from the Hospital Ethics Committee and written informed consent, 46 patients, American Society of Anesthesiologists physical status (ASA) I-II, aged between 22-62 years undergoing elective general surgery, were enrolled in this prospective study. Patients were excluded if they had any evidence of cardiovascular diseases or taking medication, which may affect the QTc interval such as quinidine, sotalol, disopyramide and had abnormal prolongation of the QTc interval (>440 ms).

Patients received no premedication. After being taken into the operation room, patients were randomly placed into one of the sevoflurane, desflurane or propofol groups. In all patients, a 12 lead ECG was recorded before administering oxygen/air at a fraction of inspired oxygen of 0.4 via a face mask. Fresh gas flow was 4 L/ min in all groups. Ventilation was controlled via a face mask after induction. End-tidal concentration of carbon dioxide was monitored and maintained at 35-40 mmHg throughout the study.

In the desflurane group (Group 1, n = 17), anesthesia was induced using a face mask by initially administering 1.0% desflurane, then by increasing the inspiratory concentration after every fifth breath by 1.0% until a maximum concentration of 9% desflurane was achieved. Patients intolerant to the mask induction by desflurane were excluded from the study. Once anesthesia was induced, an end-tidal concentration of 1 MAC desflurane vapor was maintained to provide an adequate depth of anesthesia.

In the sevoflurane group (Group 2, n = 16), anesthesia was induced using a face mask by initially administering 1.0% sevoflurane, then by increasing the inspiratory concentration after every fifth breath by 1.0% until a maximum concentration of 5% sevoflurane was achieved. Once anesthesia was induced, an end-tidal concentration of 1 MAC sevoflurane was maintained to provide an adequate depth of anesthesia. In the propofol group (Group 3, n = 11), anesthesia was induced intravenously by using 2.5 mg/kg propofol while the patients were breathing oxygen and air at FiO 2 of 0.4. Anesthesia was maintained using a continuous infusion of propofol at a rate of 6 mg/kg / hr.

In all the three groups, 5 mins were allowed after induction of anesthesia to establish steady state condition before obtaining the second 12 lead ECG.

After the measurements were completed, anesthesia was continued according to the individual needs of patient and type of surgical intervention by using opioids, muscle relaxants, and tracheal intubation.

The investigators reading the ECG were blinded to the type of induction and anesthesia used. The following variables were recorded or calculated: Heart rate; systolic blood pressure; diastolic blood pressure; PR interval; QRS interval; QT interval (max and min); QTd; QTc interval (max, min), according to the Bazett's formula (QTc: QT/√RR sec); [9,[10] QTcd; P (max, min); and Pd as defined previously. [11] For calculating these parameters, ECG recordings were taken at 1 st and 5 th minutes after induction. For each ECG record,a random selection of ten different beats was used; the parameters were measured via micrometer on ECG.

Statistical analysis

Demographic data were analyzed among groups by Pearson's Chi-square (χ2 ) test. The scale variables of the three groups were tested by one-way ANOVA test in parametric and Kruskal Wallis test in nonparametric variables. Two levels of the same group were tested by paired samples t- test in parametric and Wilcoxon signed ranks test in non-parametric variables. After one-way ANOVA and Kruskal Wallis tests, post hoc multiple comparison tests were used to identify different pairs of groups. P < 0.05 was considered as significant in all of the tests.


   Results Top


Two patients in desflurane group were excluded from the study due to intolerance to desflurane induction. There were no demographic differences among the groups [Table 1]. While measuring QT dispersion we excluded five patients from propofol group due to bad unmeasurable ECG record in some derivations. This is the limitation of our study.

A significant decrease in systolic and diastolic blood pressure was observed in three groups ( P < 0.05). The decrease in systolic blood pressure was less significant in the desflurane group than sevoflurane and propofol groups ( P < 0.05) [Table 2]. There was no difference in the diastolic pressure between the three groups. Also, there was also no significant difference in heart rate between and within the groups [Table 2]. There were no significant ventricular or supraventricular dysrhythmias during the study and no mortality and morbidity was observed.

Induction with desflurane caused significant increase in the QTd compared to baseline (38 ± 2 vs. 62 ± 6 ms, P < 0.05). Sevoflurane and propofol were associated with a decrease in the QTd [Figure 1]. There was no significant difference in QTd between the groups.

QTcd was increased with desflurane induction and decreased with sevoflurane and propofol induction, but, only in the propofol group significantly (67 ± 5 vs. 45 ± 3 ms, P < 0.05) [Figure 2]. There was no significant difference in QTcd between the groups.

Pd was significantly increased after induction in desflurane group compared to control (34 ± 3 vs. 63 ± 6 ms, P < 0.05). Sevoflurane and propofol induction caused no significant change in Pd [Figure 3]. There was no significant difference in Pd between the groups.

When these data were suggested for power analysis,considering 25% change in QTd as significant based on previous studies, minimum sample size was calculated as 16 in one group with statistical power of 0.80 and alfa value of 0.05.


   Discussion Top


In this study desflurane decreased the systolic blood pressure less than sevoflurane and propofol compared to baseline levels. But it cannot be stated that a combination of sevoflurane and propofol is not suitable for induction of general anesthesia in noncardiac surgery patients. Moreover, in all our study groups, systolic blood pressure values were reached to baseline values in continuation of operation. Recent clinical studies have suggested that the interlead variability of the QT interval in the standard ECG defined as QT dispersion reflects regional differences in ventricular repolarization and has been shown to correlate better with the risk of dysrhythmias than QT interval itself. [10],[11],[12],[13] Homogenecity of recovery time protects against dysrhythmias, whereas dispersion of recovery time is dysrhythmogenic. QTd may be useful in the assessment of both dysrhythmia risk and the efficacy of antidysrhythmic drugs. [7],[14],[15] In our study, although desflurane significantly prolonged QTd and Pd, no significant intergroup difference was found ( P >0.05). Silay and colleagues have reported that prolonged QT inteval by desflurane and isoflurane in their study but they have reported no significant intergroup differences. [4] Also, no significant ventricular or supraventricular dysrhythmias were observed during the study.

There are several formulas for correcting the QT interval for heart rate. Although, there is debate regarding which is the best, the most commonly used is Bazette's formula. According to this formula, the accepted upper limit of normal QT, for the duration of repolarization is 440 ms. [2] The normal rate corrected QTd is between 20 and 50 ms. [14]

Yildirim et al . found that desflurane, sevoflurane and isoflurane caused significant QTd prolongation. [3] In this study, anesthesia induction was maintained by 0.3 mg/ kg midazolam and vecuronium was given for muscle relaxation. Although, desflurane, sevoflurane, and isoflurane significantly prolonged QTcd, no significant difference between the groups was observed and no cardiac dysrhythmia was found. [3] Güler and colleagues studied the effects of halothane and sevoflurane on QTd following midazolam 0.03 mg/kg im premedication: i0 nhalational induction of halothane and sevoflurane were carried out in 0.5% increments. [16] ECG recordings were performed 1 and 3 mins after reaching 2.5% halothane and 3% sevoflurane end-tidal concentration. Systemic arterial pressure progressively decreased with both agent and prolonged QTd and QTcd significantly compared with preinduction baseline values. According to them, sevoflurane and halothane, at 2 MAC concentration caused arrhythmias. The authors concluded that prolongation of QT interval may be a direct myocardial effect of the volatile anesthetics independent of change in autonomic nervous system tone.

The increased plasma concentrations of catecholamine followed by laryngoscopy and intubation may increase the afterload of the heart and as a consequence, the QTd can increase. [17] Most of the studies have not examined the effects of a single drug in unpremedicated patients and in the absence of confounding adrenergic stimulation from airway manipulation or surgery. In our study, effect of drugs was studied in unpremedicated patients before laryngoscopy and tracheal intubations.

Sevoflurane and desflurane are volatile anesthetics used for their rapid onset and offset of action and cardiovascular stability. Although, desflurane does not facilitate ventricular arrhythmias, the induction of anesthesia with desflurane can result in sympathetic stimulation, which may induce cardiac arrhythmias including ventricular arrhythmias. [18],[19] The rapid administration of desflurane up to 1.5 MAC has been associated with systemic hypertension and tachycardia. This is related to rapid increase in sympathetic activity and norepinephrine and epinephrine release. In vitro studies have also shown that desflurane may induce intramyocardial catecholamine release. [19] We used 1 MAC of desflurane in unpremedicated patients and found significant increase in QTd. In our study decrease in blood pressure was less pronounced in desflurane. Similar to our results, Beausier et al . concluded that desflurane was better than isoflurane for establishment of hypotension during spinal surgery. [20] Reason for lesser decrease in blood pressure and QTd increase in desflurane group may be related to its sympathetic activity.

Propofol appears to be potentially beneficial with respect to the QTc interval and QTd in individuals at high risk of torsade de pointes (TdP). [21] Simon et al . investigated the effects of propofol and sevoflurane on the QTc and Tp-e intervals (the interval from the peak to the end of the T-wave) may be used as a measure of transmural dispersion of repolarization) in 50 unpremedicated children. They found that 3% end tidal sevoflurane increased the duration of myocardial depolarization in children to a larger extent than did 3 mg/kg propofol but dispersion of repolarization appears unaffected. In our study 2.5 mg/kg propofol, following 6 mg/kg / h infusion decreased the QTcd significantly.

Prolonged P-wave duration and increased P-wave dispersion have been reported to carry an increased risk for atrial fibrillation. [22],[23] Moreover the correlation between interatrial and intraatrial conduction abnormalities and the induction of paroxysmal atrial fibrillation has been well documented. [23],[24] Pd has been studied during some cardiac conditions such as hypertension, paroxysmal atrial fibrillation, mitral stenosis, aortic stenosis, spontaneous angina pectoris, coronary angioplasty, and in healthy subjects regarding the relation between age and Pd. [23],[25],[26],[27] Cheema et al . studied the effect of epinephrine on signal-averaged P-wave duration in healthy young subjects and found that epinephrine resulted in significant prolongation of P-wave duration. [28] Tükek et al . have reported that increased sympathetic activity causes a significant increase in Pd. [29] To our knowledge, the present study is the first one to study the effect of anesthetic agents on Pd, which shows that desflurane increases the Pd significantly.

The most recent American College of Cardiology (ACC)/American Heart Association (AHA) guidelines recommend the use of volatile anesthetic agents during noncardiac surgery for the maintenance of general anesthesia in patients at risk for MI. [30] Despite the lack of evidence in this setting, Kersten and Fleisner defined in their editor letter that desflurane and sevoflurane are protective against myocardial ischemia in hemodynamically stable patients. [31] A recent meta-analysis showed that desflurane and sevoflurane reduce postoperative mortality and incidence of myocardial infarction (MI) following cardiac surgery. This metaanalysis summed up patients in terms of postoperative cardiac troponin (cTn) release, need for inotropic support, time on mechanical ventilation, intensive care unit (ICU), and overall hospital stay. [32]

Our findings may have some limitations, for example, we excluded five patients from our study due to improper ECG records. Patient population may be enlarged in this model to reach a more accurate estimation. But our goal is to find out the sole effect of desflurane by using it in anesthetic induction.

In conclusion, we investigated specific, individual effects of desflurane, sevoflurane, and propofol, found no significant difference between the groups in QTc, QTcd and Pd. Though a significant increase of QTd and Pd was observed in the desflurane group, dangerous arrhythmias were not seen. We believe that this conclusion demands further investigations to define the role of desflurane in patients with prolonged QT syndrome.

 
   References Top

1.Tanskanen PE, Kytta JV, Randell TT. QT interval and QT dispersion during the induction of anaesthesia in patients with subarachnoid hemorrhage: A comparison of thiopental and propofol. Eur J Anaesthesiol 2002;19:749-54.  Back to cited text no. 1    
2.Whyte S, Booker PD, Buckley DG. The effects of propofol and sevoflurane on the QT interval and transmural dispersion of repolarization in children. Anesth Analg 2005;100:71-7.  Back to cited text no. 2    
3.Yildirim H, Adanir T, Atay A, Katircioπlu K, Savaci S. The effects of sevoflurane, isoflurane and desflurane. Eur J Anaesthesiol 2004;21:566-70.  Back to cited text no. 3    
4.Silay E, Kati I, Tekin M, Güler, Hüseyinoπlu U, Coskuner I, et al. Comparison of effects of desflurane and sevoflurane on the QTc interval and QT dispersion. Acta Cardiol 2005;60:459-64.  Back to cited text no. 4    
5.Shah RR. Drug-induced QT dispersion: d0 oes it predict the risk of torsade de pointes? J Electrocardiol 2005 38:10-8.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Gulcan O, Sezgin A, Demircan S, Atalay H, Turkoz R. Effect of coronary artery bypass grafting and aneurysmectomy on QT dispersion in moderate or severe left ventricular dysfunction. Am Heart J 2005;149:917-20.  Back to cited text no. 6    
7.Aypar E, Karagoz AH, Ozer S, Celiker A, Ocal T. The Effects of Sevoflurane and Desflurane anesthesia on QTc interval and cardiac rhythm in children: Paediatr Anaesth 2007;17:563-7.  Back to cited text no. 7    
8.Erbay AR, Turhan H, Yasar AS, Bicer A, Senen K, Sasmaz H, et al . Effects of long-term beta-blocker therapy on P-wave duration and dispersion in patients with rheumatic mitral stenosis. Int J Cardiol 2005;102:33-7.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]
9.Algra A, Tijssen JGP, Roelandt JR, Pool J, Lubsen J. QTc prolongation measured by standard 12-lead electrocardiography is an independent risk factor for sudden death due to cardiac arrest. Circulation 1991;83:1888-94.  Back to cited text no. 9    
10.Riley DC, Schemeling WT, Al-Wathiqui MH, Kampine JP, Warltier DC. Prolongation of the QT interval by volatile anesthetics in chronically instrumental dogs. Anesth Analg 1988;67:741-9.  Back to cited text no. 10    
11.Garson A. JR, Dick M, Fournier A, Gillette PC, Hamilton R, Kugler JD, et al . The long QT syndrome in children. An international study of 287 patients. Circulation 1993;87:1866-72.  Back to cited text no. 11    
12.Perkiomaki JS, Huikuri HV, Koistinen JM, Mδkikallio T, Castellanos A, Myerburg RJ. Heart rate variability and dispersion of QT interval in patients with vulnerability to ventricular tachycardia and ventricular fibrillation after previous myocardial infarction. J Am Coll Cardiol 1997;30:1331-8.  Back to cited text no. 12    
13.Day CP, McComp JM, Campbell RW: QT dispersion: a0 n indication of arrhythmia risk in patients with long QT intervals. Br Heart J 1990;63:342-4.  Back to cited text no. 13    
14.Higham PD, Campbell RW. QT dispersion: Br Heart J 1994;71:508-10. Review.  Back to cited text no. 14    
15.Turhan H, Yetkin E, Atak R, Altinok T, Senen K, Ileri M, et al . Increased Pwave duration and P-wave dispersion in patients with aortic stenosis. Ann Noninvasive Electrocardiol 2003;8:18-21.  Back to cited text no. 15  [PUBMED]  [FULLTEXT]
16.Güler N, Bilge M, Eryenucu B, Kati I, Demirel CB. The effects of halothane and sevoflurane on QT dispersion. Acta Cardiol 1999;54:311-5.  Back to cited text no. 16    
17.Yee KM, Lim PO, Ogston SA, Struthers AD. Effect of phenylephrine with and without atropine on QT dispersion in healthy normotensive men. Am J Cardiol 2000;85:69-74.  Back to cited text no. 17  [PUBMED]  [FULLTEXT]
18.Mahla E, Rotman B, Rehak P, Atlee JL, Gombotz H, Berger J, et al . Perioperative ventricular dysrhythmias in patients with structural heart disease undergoing noncardiac surgery. Anesth Analg 1998;86:16-21.  Back to cited text no. 18  [PUBMED]  [FULLTEXT]
19.Malik M, Batchvarov VN. Measurement, Interpretation and Clinical Potential of QT Dispersion. J Am Coll Cardiol 2000;36:1749-66.  Back to cited text no. 19  [PUBMED]  [FULLTEXT]
20.Beaussier M, Paugam C, Deriaz H, Mestari M, Chandon M, Sautet A, et al. Haemodynamic stability during moderate hypotensive anesthesia for spinal surgery: A comparison between desflurane and sevoflurane. Acta Anaesthesiol Scand 2000;44:1154-9.  Back to cited text no. 20    
21.Michaloudis D, Fraidakis O, Lefaki T, Dede I, Kanakoudes F, Askitopoulou H, et al . Anaesthesia and the QT interval in humans. The effects of isoflurane and halothane. Anaesthesia 1996;51:219-24.  Back to cited text no. 21    
22.Dilaveris PE, Gialafos EJ, Sideris S, Theopistou AM, Andrikopoulos GK, Kyriakidis M, et al . Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 1998;135:733-8.  Back to cited text no. 22    
23.Aytemir K, Ozer N, Atalar E, Sade E, Aksφyek S, Ovünη K, et al . P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2000;23:1109-12.  Back to cited text no. 23    
24.Buxton AE, Waxman HL, Marchlinski FE, Josephson ME. Atrial conduction: e0 ffects of extrastimuli with and without atrial dysrhythmias. Am J Cardiol 1984;54:755-61.  Back to cited text no. 24  [PUBMED]  [FULLTEXT]
25.Turhan H, Yetkin E, Senen K, Yilmaz MB, Ileri M, Atak R, et al . Effects of percutaneous mitral balloon valvuloplasty on P-wave dispersion in patients with mitral stenosis. Am J Cardiol 2002;89:607-9.  Back to cited text no. 25  [PUBMED]  [FULLTEXT]
26.Dilaveris PE, Andrikopoulos GK, Metaxas G, Richter DJ, Avgeropoulou CK, Androulakis AM, et al . Effects of ischemia on P wave dispersion and maximum P wave duration during spontaneous anginal episodes. Pacing Clin Electrophysiol 1999;22:1640-7.  Back to cited text no. 26  [PUBMED]  
27.Cagli K, Gol MK, Keles T, Sener E, Yildiz U, Uncu H, et al . Risk factors associated with development of atrial fibrillation early after coronary artery bypass grafting. Am J Cardiol 2000;85:1259-61.  Back to cited text no. 27    
28.Cheema AN, Ahmed MW, Kadish AH, Goldberger JJ. Effects of autonomic stimulation and blockade on signal-averaged P wave duration. J Am Coll Cardiol 1995;26:497-502.  Back to cited text no. 28  [PUBMED]  [FULLTEXT]
29.Tukek T, Akkaya V, Demirel S, Sφzen AB, Kudat H, Atilgan D, et al . Effect of valsalva maneuver on surface electrocardiographic P wave dispersion in paroxysmal atrial fibrillation. Am J Cardiol 2000;85:896-9,A10.  Back to cited text no. 29    
30.Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, et al . ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). J Am Coll Cardiol 2007;50:1707-32.  Back to cited text no. 30    
31.Landoni G, Fochi O, Zangrillo A. Cardioprotection by volatile anesthetics in noncardiac surgery? No, not yet at least. J Am Coll Cardiol 2008;51:1321; author reply 1321-2.  Back to cited text no. 31    
32.Landoni G, Biondi-Zoccai GG, Zangrillo A, Bignami E, D'Avolio S, Marchetti C, et al . Desflurane and sevoflurane in cardiac surgery: A meta-analysis of randomized clinical trials. J Cardiothorac Vasc Anesth 2007;21:502-11.  Back to cited text no. 32  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Dilek Kazanci
Yasamkent Mah. 3222/1 sokak Armoni sitesi 3. Blok Daire: 5 Yenimahalle/ANKARA
Turkey
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DOI: 10.4103/0971-9784.51361

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    Tables

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11 Effects of esmolol, lidocaine and fentanyl on P wave dispersion, QT, QTc intervals and hemodynamic responses to endotracheal intubation during propofol induction: a comparative study
Volkan Hanci,Serhan Yurtlu,Turgut Karabag,Dilek Okyay,Sedat Hakimoglu,Gülay Kayhan,Çagatay Büyükuysal,Hilal Ayoglu,Isil Özkoçak Turan
Brazilian Journal of Anesthesiology. 2013; 63(3): 235
[Pubmed] | [DOI]
12 QT interval abnormalities: risk factors and perioperative management in long QT syndromes and Torsades de Pointes
Alan David Kaye,Jacqueline Volpi-Abadie,J. Michael Bensler,Adam M. Kaye,James H. Diaz
Journal of Anesthesia. 2013; 27(4): 575
[Pubmed] | [DOI]
13 Effects of Esmolol, Lidocaine and Fentanyl on P Wave Dispersion, QT, QTc Intervals and Hemodynamic Responses to Endotracheal Intubation During Propofol Induction: a Comparative Study
Volkan Hanci,Serhan Yurtlu,Turgut Karabag,Dilek Okyay,Sedat Hakimoglu,Gülay Kayhan,Çagatay Büyükuysal,Hilal Ayoglu,Isil Özkoçak Turan
Brazilian Journal of Anesthesiology (English Edition). 2013; 63(3): 235
[Pubmed] | [DOI]
14 Impact of anaesthetic drugs and adjuvants on ECG markers of torsadogenicity
C. Staikou,M. Stamelos,E. Stavroulakis
British Journal of Anaesthesia. 2013;
[Pubmed] | [DOI]
15 Efectos del Esmolol, de la Lidocaína y del Fentanilo en los Intervalos Dispersión de la Onda, QT, QTc y Respuestas Hemodinámicas a la Intubación Endotraqueal Durante Inducción con Propofol: un Estudio Comparativo
Volkan Hanci,Serhan Yurtlu,Turgut Karabag,Dilek Okyay,Sedat Hakimoglu,Gülay Kayhan,Çagatay Büyükuysal,Hilal Ayoglu,Isil Özkoçak Turan
Brazilian Journal of Anesthesiology (Edicion en Espanol). 2013; 63(3): 235
[Pubmed] | [DOI]
16 The Effect of Levobupivacaine and Bupivacaine on QT, Corrected QT (Qtc), and P Wave Dispersions in Cesarean Section
Deniz, Y. and Okyay, D. and Hanci, V. and Yurtlu, S. and Ayoĝlu, H. and Özkocak Turan, I.
Revista Brasileira de Anestesiologia. 2013; 63(2): 202-208
[Pubmed]
17 Effects of esmolol, lidocaine and fentanyl on P wave dispersion, QT, QTc intervals and hemodynamic responses to endotracheal intubation during propofol induction: A comparative study
Hanci, V. and Yurtlu, S. and Karabaĝ, T. and Okyay, D. and Hakimoĝlu, S. and Kayhan, G. and Büyükuysal, T. and Ayoĝlu, H. and özkoçak Turan, I.
Revista Brasileira de Anestesiologia. 2013; 63(3): 235-244
[Pubmed]
18 Impact of propofol on electrocardiographic alterations during intravascular application of bupivacaine - A study in piglets
Mauch, J.Y. and Kutter, A.P.N. and Martin Jurado, O. and Madjdpour, C. and Spielmann, N. and Frotzler, A. and Bettschart-Wolfensberger, R. and Weiss, M.
Paediatric Anaesthesia. 2011; 21(2): 136-140
[Pubmed]
19 A comparison of the effects of desflurane, sevoflurane and propofol on on QT, QTc and P dispersion on ECG
Ege, M., Guray, Y.
Annals of Cardiac Anaesthesia. 2011; 14(1): 65
[Pubmed]
20 Impact of propofol on electrocardiographic alterations during intravascular application of bupivacaine - a study in piglets : PROPOFOL- AND LOCAL ANESTHETIC-RELATED ECG ALTERATIONS
Jacqueline Y. Mauch, Annette P. N. Kutter, Olga Martin Jurado, Caveh Madjdpour, Nelly Spielmann, Angela Frotzler, Regula Bettschart-Wolfensberger, Markus Weiss
Pediatric Anesthesia. 2011; 21(2): 136
[VIEW] | [DOI]
21 Does electrocardiography at admission predict outcome in Crimean-Congo hemorrhagic fever?
Yilmaz, M.B., Engin, A., Bektasoglu, G., Zorlu, A., Meltem, R., Bakir, M., Dokmetas, I.
Journal of Vector Borne Diseases. 2011; 48(3): 150-154
[Pubmed]
22 Ventricular tachycardia after ondansetron administration in a child with undiagnosed long QT syndrome
Kyle McKechnie, Alison Froese
Canadian Journal of Anesthesia/Journal canadien d anesthésie. 2010; 57(5): 453
[VIEW] | [DOI]



 

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