Anesthesia for children with long QT syndrome

Anaesthesia for children with long QT syndrome Samia I. Sharaf , M.D Ain Shams University

Long QT Syndrome In Children ( LQS) ,[object Object]

What Is QT Interval ? How It Is Measured ? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Classification Of LQTS ,[object Object],[object Object],[object Object],[object Object]

How QT Interval Is Prolonged ? ,[object Object],[object Object],[object Object],[object Object]

Congenital Long QT Syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Congenital Long QT Syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object]

Genotypes Of Long QT Syndrome Ion channel affected Chromosome/gene Frequency Phenotype Genotype K+(1K S ) 11-KVLQT1 +++ LQT1 LQT1 K+(1K R ) 7-HERG ++ LQT2 LQT2 NA+ 3-SCN5A + LQT3 LQT3 UNKNOWN UNKNOWN - LQT4 K+(1K S ) 21-KCNE1 - LQT1 LQT5 K+(1K R ) 21-KCNE2 - LQT2 LQT6

Clinical Picture Of c-LQTS ,[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical Outcome Of c-LQTS ,[object Object],[object Object],[object Object]

C-LQTS: Diagnosis, Schwartz Score ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

c-LQTS: Diagnosis, Schwartz Score ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Acquired LQTS Quinidine,procainamide,disopyramide,sotalol,amiodarone Antidysrhythmic drugs Terfenadine,astemizole Histamine receptor antagonists Erythromycin,clindamycin,imidazole,ampicillin Antibiotics Ketanserin,flouxetine Drugs acting on serotonin receptors Tetra-and tricyclic antidepressant , haloperidol,phenothiazine,lithium,risperidone Antipsychotic drugs indapamide Diuretics Massive blood transfusion Citrate Cisapride Gastrointestinal drugs Hypokalemia , hypomagnesemia, hypocalcaemia Metabolic abnormalities Complete atrioventricular block Bradydysrhythmias Myocardial ischemis,acute carditis,acute cor pulmonale, mitral valve prolapse Cardiac Anorexia nervosa,gastroplasty,liquid protein diet Starvation Subarachinoid hge. Head injury,right-sided radial neck surgery Nervous system injury Hypothermia, pituitary insufficiency Others

Treatment OF c-LQTS ,[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment Of Torsade De Pointes Mechanism Of Torsade De Pointes ,[object Object],[object Object],[object Object],[object Object]

Treatment ,[object Object],[object Object],[object Object],[object Object]

Drugs Well Documented To Prolong QT Interval Relevant To Anesthetic Practice ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Drugs That Prolong QT Interval In Documented Case Reports ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Drugs To Be Avoided In Patients With c-LQTS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Anesthesia For Patients With c-LQTS General considerations ,[object Object],[object Object],[object Object],[object Object],[object Object]

General Considerations For Conduct Of Anesthesia In Patients With c-LQTS ,[object Object],[object Object],[object Object],[object Object]

General Considerations For Conduct Of Anesthesia In Patients With c-LQTS ,[object Object],[object Object],[object Object]

Although information of the effect of some anaesthetic drugs on QT were available before significance of TDR of M cells yet the clinical significance is often unclear & it is difficult to advise with authority on which the safest anaesthetic agent for LQTS Anaesthetic Drugs & Ventricular Repolarization

Premedication ,[object Object],[object Object],[object Object],[object Object],[object Object]

Intravenous Agents ,[object Object],[object Object],[object Object],[object Object]

Effects Of Sevoflurane Versus Propofol On QT interval Paventi S, Santevecchi A, Ranieri R. ,[object Object],[object Object]

Methohexital : prolongs QTC in healthy adults but not in children ( despite atropine premedication ) Act. Anaesthesiol Scand, 1993 ketamine : unreported effect , better avoided Etomidate : has no significant effect Act. Anaesthesiol Scand 1994

Volatile Anesthetics Effects of Sevoflurane versus Propofol on QT interval . Paventi S, Santevecchi A, Ranieri R. ,[object Object],[object Object]

Volatile Anesthetics The effects of sevoflurane, isoflurane and desflurane on QT interval of the ECG. Yildirim H, Adanir T, Aday A, Katircioglu K. Savaci S . ,[object Object],[object Object]

Volatile Anesthetics Anaesthesia and the QT interval in humans. The effects of isoflurane and halothane. Michaloudis D, Fraidakis O, Lefaki T, Dede I, Kanakoudes F, Askitopoulou H, Pollard BJ. ,[object Object],[object Object]

Volatile Anesthetics Anaesthesia and the QT interval. Effects of isoflurane and halothane in unpremedicated children. Michaloudis D, Fraidakis O, Petrou A. Gigourtsi C, Parthenakis F. ,[object Object],[object Object]

Muscle Relaxants The effects of midazolam followed by administration of either vecuronium or atracurium on the QT interval in humans. Michaloudis DG, Kanakoudis FS, Xatzkraniotis A, Bischiniotis TS ,[object Object],[object Object]

Muscle Relaxants The effects of midazolam or propofol followed by suxamethonium on the QT interval in humans. Michaloudis DG, Kanakoudis FS, Petrou AM, Konstantinidou AS, Pollard BJ. ,[object Object],[object Object]

Muscle Relaxants ,[object Object],[object Object],[object Object]

Neuromuscular Reversal Effects of four anticholinesterse-anticholinergic combinations and tracheal extubation on QTc interval of the ECG, heart rate and arterial pressure. Saarnivaara L, Simola M. ,[object Object],[object Object]

Antiemetics Prolongation of QTc interval after postoperative nausea and vomiting treatment by droperidol or ondansetron . Charbit B, Albaladerjo P, Funck-Brentano C, Legrand M, Samain E, Marty J ,[object Object],[object Object]

Antiemetics Effect of low-dose droperidol on the QT interval during and after general anesthesia: a placebo controlled study White PF, Song D, Abrao J, Klein KW, Navarette B. ,[object Object],[object Object]

Narcotics ,[object Object],[object Object],[object Object],[object Object]

Anesthesia for children with long QT syndrome

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Anesthesia for children with long QT syndrome