Effects Of Sevoflurane Combined With Remifentanil General Anesthesia On Intraoperative QT Interval And Arrhythmia In Elderly Patients Undergoing Transurethral Resection Of Prostate

Background and objective:Sevoflurane has been safely used as a new general anesthetic in clinical anesthesia for more than 20 years,but its effect on prolonging the QT interval is commonly reported.In elderly male patients undergoing transurethral resection of the prostate（TURP）,the QT interval may be prolonged due to intraoperative hypothermia and electrolyte disturbance.Whether intraoperative application of sevoflurane may cause further prolongation of the QT interval has not been reported.Therefore,in this study,we observed the intraoperative QT interval（QT）,corrected QT interval（QTc）,corrected QT interval dispersion（QTcd）and the occurrence of intraoperative arrhythmias in elderly male patients of TURP under sevoflurane combined with remifentanil general anesthesia.To investigate the safety of sevoflurane for general anesthesia in elderly male patients with TURP.Methods:Male patients undergoing elective TURP at the First Hospital of Jilin University from February 2022 to November 2022,aged 60～75 years old,with ASA classification I～III were selected.Eighty-four patients meeting the criteria were selected and randomly assigned to two groups A and B.Group A was the combined intravenous and inhalation anesthesia group（n=42）,and group B was the total intravenous anesthesia group（n=42）.Patients in both groups were induced with the same anaesthetic,while different anesthesia maintenance protocols were used according to the grouping.Group A:sevoflurane（0.6～1.0 MAC）;Group B:propofol(3～6 mg·kg^-1·h^-1).Both groups were given remifentanil(0.1～0.3μg·kg^-1·h^-1)continuously.The general information of the patients was recorded.The heart rate（HR）,mean atrial pressure（MAP）,nasopharynx temperature（NT）,QT,QTc and QTcd of the patients were recorded at 5 min after the patient was admitted to the room（T0）,15 min after the start of surgery（T1）,30 min after the start of surgery（T2）,60 min after the start of surgery（T3）,immediately after the surgery（T4）and immediately after the patient was discharged from the operating room（T5）.And the arterial blood gas concentrations of sodium,potassium,calcium,blood glucose,arterial partial pressure of carbon dioxide（Pa CO₂）and p H were recorded at T0 and T5.The occurrence of intraoperative arrhythmias was recorded.Results:（1）In terms of QT:QT was significantly prolonged from T1 to T4 in group A compared with group B（P<0.01）;QT was prolonged significantly from T1 to T5compared with T0 in both group A and B（P<0.05）.（2）In terms of QTc:QTc was prolonged at time point T3 in group A compared with group B（P<0.05）;QTc was prolonged significantly from T1 to T5 compared with T0 in group A（P<0.05）;QTc was prolonged significantly at T3 compared with T0 in group B（P<0.05）.（3）In terms of QTcd:QTcd was not significantly different between two groups at each time point（P>0.05）;QTcd was prolonged significantly from T1 to T5 compared with T0 in both groups（P<0.05）.（4）In terms of MAP:At T2～T4,the MAP of group A was higher than group B significantly（P<0.05）.（5）In terms of arterial blood gas analysis:compared with T0,serum sodium ion concentration had decreased,blood glucose concentration had increased and Pa CO₂ had decreased at T5,and the differences were statistically significant（P<0.05）.Conclusion:Compared with propofol combined with remifentanil total intravenous anesthesia,sevoflurane combined with remifentanil intravenous and inhalation anesthesia can prolong intraoperative QT and QTc,but it can not prolong QTcd significantly,with more steady intraoperative hemodynamics and no arrhythmias during the TURP,which can be safely applied to the anesthesia for TURP in elderly male patients with normal preoperative QT interval within 2 hours.