Intravenous palonosetron increases the incidence of QTc prolongation during sevoflurane general anesthesia for laparotomy

Abstract

Background: Palonosetron is a recently introduced 5-hydroxytryptamine-3 (5-HT3) receptor antagonist useful for postoperative nausea and vomiting prophylaxis. However, 5-HT3 receptor antagonists increase the corrected QT (QTc) interval in patients who undergo general anesthesia. This retrospective study was performed to evaluate whether palono-setron would induce a QTc prolongation in patients undergoing general anesthesia with sevofurane. Methods: We reviewed a database of 81 patients who underwent general anesthesia with sevofurane. We divided the records into palonosetron (n = 41) and control (n = 40) groups according to the use of intraoperative palonosetron, and analyzed the electrocardiographic data before anesthesia and 30, 60, 90, and 120 min after skin incision. Changes in the QTc interval from baseline, mean blood pressure, heart rate, body temperature, and sevofurane concentrations at each time point were compared between the two groups. Results: Te QTc intervals at skin incision, and 30, 60, 90, and 120 min after the skin incision during general anesthesia were significantly longer than those at baseline in the two groups (P < 0.001). Te changes in the QTc intervals were not different between the two groups (P = 0.41). However, six patients in the palonosetron group showed a QTc interval > 500 ms 30 min after skin incision, whereas no patient did in the control group (P = 0.01). No significant differences were observed between the two groups in mean blood pressure, body temperature, heart rate, or sevofurane concentrations. Conclusions: Palonosetron may induce QTc prolongation during the early general anesthesia period with sevofurane. © the Korean Society of Anesthesiologists, 2013.