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Impact of thoracic epidural sympathetic block on cardiac repolarization

Authors Komatsuzaki M, Takasusuki T, Yamaguchi S

Received 2 August 2018

Accepted for publication 17 September 2018

Published 16 October 2018 Volume 2018:11 Pages 81—85

DOI https://doi.org/10.2147/LRA.S182402

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Stefan Wirz


Makoto Komatsuzaki, Toshifumi Takasusuki, Shigeki Yamaguchi

Department of Anesthesiology, Dokkyo Medical University, School of Medicine, Mibu, Tochigi 321-0293, Japan

Purpose: The interval from the peak to the end of the T wave (Tp–Te) on electrocardiography is considered a marker of ventricular arrhythmias. A previous study suggested that right stellate ganglion block prolonged QT and QT dispersion (QTD). We investigated the effect of thoracic epidural sympathetic block with 1% mepivacaine on QT, QTD, Tp–Te, and Tp–Te/QT by using computerized measurement.
Patients and methods: After obtaining the approval of the ethics committee of Dokkyo Medical University Hospital, 23 patients with American Society of Anesthesiologists physical status I or II who were scheduled to undergo thoracic surgery were enrolled. An epidural catheter was inserted at the Th4–5 or 5–6 level and then used for injection of 7 mL of 1% mepivacaine. Changes in RR interval, QT, corrected QT (QTc), QTD, QTc dispersion (QTcD), Tp–Te, Tp–Te/QT, and Tp–Te/QTc before and after epidural injection were assessed by computerized measurement. Statistical analysis was performed by one-way ANOVA.
Results: Systolic blood pressure was consistently suppressed 10–15 minutes after injection (baseline: 136±10 mmHg, 11 minutes: 113±12 mmHg, 12 minutes: 112±13 mmHg, 13 minutes: 112±12 mmHg, 14 minutes: 108±17 mmHg, 15 minutes: 111±14 mmHg; P<0.05). However, RR interval, QT, QTc, QTD, QTcD, Tp–Te, Tp–Te/QT, and Tp–Te/QTc were not changed after epidural block.
Conclusion: Thoracic epidural injection of 1% mepivacaine did not alter QT, QTc, QTD, QTcD, Tp–Te, Tp–Te/QT, or Tp–Te/QTc. These results emphasize the safety of thoracic epidural sympathetic block with 1% mepivacaine for patients compared with right stellate ganglion block, in terms of cardiac repolarization.

Keywords: thoracic epidural block, QT interval, QT dispersion, Tpeak–Tend, mepivacaine

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