Propofol-based total intravenous Anesthesia (TIVA) vs Desflurane on corrected QT interval (QTc) values during living donor liver transplantation
Propofol-based total intravenous anesthesia (TIVA)] vs desflurane on corrected QT interval (QTc) values during living donor liver transplantation. QT interval prolongation is seen in cirrhotic cardiomyopathy. This may cause ventricular arrythmias like torsades de pointes and sudden cardiac death which may occur during liver transplantation. Inhalational anesthesia using desflurane is commonly favored during liver transplantation. However, studies have reported that desflurane can cause prolongation of the QT interval. Prolongation of the QT interval by propofol has also been previously reported (1,2). No previous study has compared the effect of desflurane and Total Intravenous Anesthesia (TIVA) using propofol on QTc prolongation during liver transplantation. Recently, researchers in Korea carried out a study which compared desflurane inhalation anesthesia and propofol based TIVA. The study is summarized below.
To compare the effects of two anesthetic methods (desflurane inhalation anesthesia vs. propofol-based TIVA on corrected QT interval (QTc) values during living donor liver transplantation.
A total of 120 patients who underwent living donor liver transplantation were randomized to either the desflurane (n=60) or TIVA (n=60).
The primary outcome was intraoperative QTc change.
Other electrocardiogram, hemodynamic findings and postoperative outcomes.
• QTc values were prolonged intraoperatively in both groups; however, the change was smaller in the TIVA group than in the desflurane group (PGroup × Time < 0.001).
• QTc values of > 500 ms were more in the desflurane group compared to the TIVA group (63.3% vs. 28.3%, P < 0.001).
• n patients with preoperative QTc prolongation, QTc was further prolonged in the desflurane group, but not in the TIVA group (PGroup × Time < 0.001) in the patients who had a preoperative QTc prolongation.
• Intraoperative norepinephrine and vasopressin use were higher in the desflurane group than in the TIVA group.
• QTc prolongation during living donor liver transplantation may be reduced by Propofol-based TIVA compared to those observed with desflurane inhalational anesthesia, particularly in patients with preoperative QTc prolongation.
• Patients managed with propofol-based TIVA required less vasopressor during the procedure compared to those managed with desflurane inhalational anesthesia.
You can access the full article at https://www.nature.com/articles/s41598-022-08592-4
1. McConachie, I., Keaveny, J. P., Healy, T. E., Vohra, S. & Million, L. Effect of anaesthesia on the QT interval. Br. J. Anaesth. 63, 558–560. https://doi.org/10.1093/bja/63.5.558 (1989).
2. Kim, D. H. et al. Effects of target concentration infusion of propofol and tracheal intubation on QTc interval. Anaesthesia 63, 1061–1064. https://doi.org/10.1111/j.1365-2044.2008.05564.x (2008).
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Balanced Crystalloids vs Normal Saline in Sepsis: A Metanalysis
• Normal saline is the most widely used crystalloid solution. There is emerging evidence suggesting that balanced crystalloids which have more physiological levels of sodium and chloride may have certain advantages over normal saline, particularly with regard to the development of hypercritical metabolic acidosis
• A recently published meta-analysis compared normal saline and balanced crystalloids in adults with sepsis.
Conduct a comprehensive systematic review and meta-analysis to include all relevant studies to assess the effect of Balanced Crystalloids vs Normal Saline on different clinical outcomes for adults with sepsis.
• A systematic search of PubMed, EMBASE, and Web of Sciences databases through 22 January 2022, was performed for studies that compared Balanced Crystalloids (BC) vs Normal Saline (NS) in adults with sepsis.
• Fifteen studies involving 20,329 patients were included in the analysis.
Study outcomes included mortality and acute kidney injury (AKI), need for renal replacement therapy (RRT), and ICU length of stay (LOS).
• Reduced mortality associated with Balanced Crystalloids compared to Normal Saline in patients with Sepsis.
• No significant differences in mortality between the groups when sub-group analysis of RCTs was conducted.
• There was no significant difference in the need for RRT or ICU LOS between BC and NS.
• Pending further data, the current study supports using BC over NS for fluid resuscitation in adults with sepsis.
• Further large-scale RCTs needed to validate the finding
You can access the full article at t https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8133105/