Newly Published
Perioperative Medicine  |   November 2019
Electrocardiographic Effects of Propofol versus Etomidate in Patients with Brugada Syndrome
Author Notes
  • From the Department of Anesthesiology and Perioperative Medicine (P.F., H.C., J.T.B., S.B., V.U., C.V., P.F., J.P.) and the Heart Rhythm Management Center, Center of Heart and Vascular Disease (V.V., W.D., G-B.,C., P.B., C.d.A.), University Hospital Brussels; and the Interfaculty Center Data processing & Statistics (W.C.), Free University Brussels, Laarbeeklaan, Brussels, Belgium.
  • Part of this work has been presented at Euroanaesthesia 2018 in Copenhagen, Denmark on July 4, 2018.
    Part of this work has been presented at Euroanaesthesia 2018 in Copenhagen, Denmark on July 4, 2018.×
  • Submitted for publication October 24, 2018. Accepted for publication September 26, 2019.
    Submitted for publication October 24, 2018. Accepted for publication September 26, 2019.×
  • Correspondence: Address correspondence to Dr. Flamée: Department of Anesthesiology and Perioperative Medicine, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium. E-mail: Panagiotis.Flamee@uzbrussel.be. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Cardiovascular Anesthesia / Pharmacology
Perioperative Medicine   |   November 2019
Electrocardiographic Effects of Propofol versus Etomidate in Patients with Brugada Syndrome
Anesthesiology Newly Published on November 13, 2019. doi:https://doi.org/10.1097/ALN.0000000000003030
Anesthesiology Newly Published on November 13, 2019. doi:https://doi.org/10.1097/ALN.0000000000003030
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Brugada syndrome is an inherited cardiac ion channel disorder that places patients at increased risk of cardiac arrhythmias including those resulting in sudden cardiac death.

  • While there is concern that propofol use may trigger life-threatening ventricular arrhythmias in patients with Brugada syndrome, this has not been assessed using prospective randomized, controlled trials.

What This Article Tells Us That Is New:

  • This study was a prospective randomized double-blind trial that compared groups receiving propofol (n = 43) versus etomidate (n = 37) for induction of general anesthesia. No significant difference in electrocardiographic changes was observed between these two groups.

Background: Brugada Syndrome is an inherited arrhythmogenic disease, characterized by the typical coved type ST-segment elevation in the right precordial leads from V1 through V3. The BrugadaDrugs.org Advisory Board recommends avoiding administration of propofol in patients with Brugada Syndrome. Since prospective studies are lacking, it was the purpose of this study to assess the electrocardiographic effects of propofol and etomidate on the ST- and QRS-segments. In this trial, it was hypothesized that administration of propofol or etomidate in bolus for induction of anesthesia, in patients with Brugada Syndrome, do not clinically affect the ST- and QRS-segments and do not induce arrhythmias.

Methods: In this prospective, double-blinded trial, 98 patients with established Brugada syndrome were randomized to receive propofol (2 to 3 mg/kg-1) or etomidate (0.2 to 0.3 mg/kg-1) for induction of anesthesia. The primary endpoints were the changes of the ST- and QRS-segment, and the occurrence of new arrhythmias upon induction of anesthesia.

Results: The analysis included 80 patients: 43 were administered propofol and 37 etomidate. None of the patients had a ST elevation greater than or equal to 0.2 mV, one in each group had a ST elevation of 0.15 mV. An ST depression up to −0.15mV was observed eleven times with propofol and five with etomidate. A QRS-prolongation of 25% upon induction was seen in one patient with propofol and three with etomidate. This trial failed to establish any evidence to suggest that changes in either group differed, with most percentiles being zero (median [25th, 75th], 0 [0, 0] vs. 0 [0, 0]). Finally, no new arrhythmias occurred perioperatively in both groups.

Conclusions: In this trial, there does not appear to be a significant difference in electrocardiographic changes in patients with Brugada syndrome when propofol versus etomidate were administered for induction of anesthesia. This study did not investigate electrocardiographic changes related to propofol used as an infusion for maintenance of anesthesia, so future studies would be warranted before conclusions about safety of propofol infusions in patients with Brugada syndrome can be determined.