Postoperative Nausea and Vomiting in Patients with Prolonged QTc

2018 ◽  
Author(s):  
Adam C. Adler ◽  
Mehernoor Watcha
Keyword(s):  
Postoperative Nausea ◽  
Qt Interval ◽  
Cardiac Electrophysiology ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
General Anesthetic ◽  
Qt Intervals ◽  
Prolonged Qt Interval ◽  
Prolonged Qt ◽  
First And Second Generation

Postoperative nausea and vomiting (PONV) is a very common complication after a general anesthetic. In some cases the feeling of nausea has been accredited to being worse than the actual pain. There are a number of medications that can be utilized to combat PONV. Of note, some of these agents can lead to cardiac arrhythmias. It is imperative to know which drugs may predispose patients to arrhythmias such as prolonged QT intervals as well as how to prevent or treat PONV in the patient with prolonged QT interval. This chapter discusses the basics of cardiac electrophysiology regarding the QT interval and the risks to the patient when it becomes prolonged, explains the potential effects of first- and second-generation 5-HT3 receptor antagonists on cardiac repolarization, and reviews currently used antiemetics and anticipated future developments in this field.

Postoperative Nausea and Vomiting in Patients with Prolonged QTc

2013 ◽  
Author(s):  
Shilpa Rao ◽  
Jerrold Lerman
Keyword(s):  
Postoperative Nausea ◽  
Qt Interval ◽  
Postoperative Nausea And Vomiting ◽  
Torsades De Pointes ◽  
Nausea And Vomiting ◽  
Receptor Antagonists ◽  
Prolonged Qt Interval ◽  
Prolonged Qt ◽  
Type 3 ◽  
Potential Interactions

A panoply of pharmacological and nonpharmacological strategies are currently employed to attenuate the risk of postoperative nausea and vomiting (PONV) in children, including 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists. 5-HT3 receptor antagonists can prolong the QT interval, which can be a precursor of torsades de pointes (TdP), particularly in children with congenital or acquired prolonged QT interval. This chapter summarizes the causes of prolonged QT interval, the potential interactions of prolonged QT interval with antiemetics and anesthetics, and strategies to prevent PONV.

scholarly journals 21. Prolonged QT Intervals in Patients with Out-of-Hospital Ventricular Tachycardia Cardiac Arrest

1996 ◽  
Vol 11 (S2) ◽  
pp. S40-S40
Author(s):  
William Brady ◽  
Daniel DeBehnke ◽  
Dennis Laundrie ◽  
Jeffrey A. Skiles
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Tachycardia ◽  
Qt Interval ◽  
Discharge Rate ◽  
Fire Department ◽  
Torsades De Pointes ◽  
Inclusion Criteria ◽  
Qt Intervals ◽  
Prolonged Qt Interval ◽  
Prolonged Qt

Objective: To determine the prevalence and outcome of out-of-hospital ventricular tachycardia (VT) cardiac arrest with a prolonged QT interval and to identify the subset with torsades de pointes (TdP).Methods: Design: Retrospective review. Setting: Fire department-based paramedic system. Participants: Non-traumatic VT cardiac arrest (1/91-12/94) with a supraventricular perfusing rhythm (SVPR) and a measurable QT interval. Interventions: QT interval was measured from a SVPR and corrected QT interval (QTc) was calculated (prolonged if ≥0.45 sec). VT was classified as polymorphic or monomorphic.Results: 190 patients met inclusion criteria. 51% of patients had a prolonged QTc (PQTc). The overall hospital discharge rate was 28.4%. No difference with respect to paramedic-witnessed arrests in each QTc group was found (25.8% normal QTc [NQTc] vs. 27.8% PQTc; p = 0.752). Patients with PQTc were less likely to be discharged from the hospital (19.6% vs. 37.6%; p = 0.01). Patients with PQTc were not more likely to have PVT (37% vs. 40%; p = 0.705). 16 (8.4%) patients had TdP. 27.8% of TdP and 26.8% of non-TdP patients were discharged (p = 0.912).

scholarly journals Amisulpride: tackling postoperative nausea and vomiting not a nightmare any more

2020 ◽  
Vol 9 (7) ◽  
pp. 1167
Author(s):  
Ajay Kumar ◽  
Anuj Singh ◽  
D. B. S. Brashier ◽  
Awanish Karan ◽  
S. Sharma ◽  
...  
Keyword(s):  
Postoperative Nausea ◽  
Qt Interval ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Interval Prolongation ◽  
Multicenter Studies ◽  
Qt Interval Prolongation ◽  
Gastric Aspiration ◽  
Extrapyramidal Signs ◽  
D2 Antagonist

Vomiting and nausea remains concern in postoperative patients for anaesthesiologists and surgeons. Patients remain at risk for adverse medical consequences as wound dehiscence, dehydration, electrolyte derangement’s and gastric aspiration. This entity delays discharge and is one of the causes of unanticipated admission after ambulatory surgery. Presently dopamine (D2), serotonin (5-HT3), and histamine (H1) antagonists are widely used prophylactic agents, as is the corticosteroid dexamethasone, but the incidence of postoperative nausea and vomiting (PONV) is still appreciable. Safety concerns as QT interval prolongation has led to nearly phasing out of use of D2-antagonist Droperidol, a potent and most favoured formulation. With minimal studies and randomized studies to back up the efficacy of existing modalities viz 5HT-antagonist, promethazine, metoclopramide and dimenhydrinate for management of postoperative nausea and vomiting, need for evaluation, study and incorporation into formulary for management was always persisting. Amisulpride is an anti-psychotic agent, used routinely in >50 countries worldwide is a potent but atypical D2-antagonist with minimal adverse profile mainly QT interval prolongation, extrapyramidal signs and symptoms, which had plagued out other members of same class. In addition to D2 antagonism this drug exhibits potent antagonist action against D3 receptors, implicated in the emetic response. In pre clinical studies and multiple randomized controlled multicenter studies the effectiveness and safety of low dose intra venous Amisulpride was established and approved as Barhemsys @Acacia Pharma by US Food and drug administration in February 2020. This drug will soon add to protocol-based management of PONV.

Bedside monitoring of the QT interval

1998 ◽  
Vol 7 (3) ◽  
pp. 183-189 ◽  
Author(s):  
LK Rimmer
Keyword(s):  
Ventricular Tachycardia ◽  
Qt Interval ◽  
Warning Signs ◽  
Cardiac Repolarization ◽  
Qt Intervals ◽  
Increased Risk ◽  
Prolonged Qt Interval ◽  
Clinical Interest ◽  
Prolonged Qt ◽  
Available Information

Cardiac repolarization, represented on the ECG by the QT interval, is of particular clinical interest in critical care. Once it is measured and corrected for changes in heart rate, the QT interval is known as the QTc. Measurement of the QT interval is important because a prolonged QT interval is associated with ventricular tachycardia and sudden cardiac death. Despite the serious complications associated with a prolonged QT interval, the interval is not routinely measured because a standardized method for measuring it has not been established and the length of QT interval critical to the development of ventricular tachycardia has not been determined. Much has been written about the conditions associated with prolonged QT intervals and specific actions to take when complications appear. Guidelines to be used for QT analysis in the clinical area, based on currently available information, include (1) procedures for measuring QT interval and calculating QTc, (2) procedures for QT analysis, (3) warning signs that indicate increased risk of ventricular tachycardia associated with a prolonged QT interval, and (4) actions to consider once increased risk is determined.

Prolonged QT interval during diabetic ketoacidosis: A case series

2020 ◽  
Author(s):  
Ghariani Rania ◽  
Chrif Yosra ◽  
Samar Derbal ◽  
Rihab Laamouri ◽  
Fatma Ben Dahmene ◽  
...  
Keyword(s):  
Diabetic Ketoacidosis ◽  
Qt Interval ◽  
Case Series ◽  
Prolonged Qt Interval ◽  
Prolonged Qt
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