Electrocardiographic changes predicting sudden death in propofol-related infusion syndrome
Heart RhythmPublished 28 January 2006Open access
Kevin Vernooy, Tammo Delhaas, Olaf L. Cremer, José M. Di Diego, Antonio Oliva, Carl Timmermans
Citations146
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
The findings indicate that development of an acquired Brugada-like ECG pattern in severely head-injured patients is a sign of cardiac electrical instability that predicts imminent cardiac death.
Abstract
Our findings indicate that development of an acquired Brugada-like ECG pattern in severely head-injured patients is a sign of cardiac electrical instability that predicts imminent cardiac death. Future studies will determine whether such an ECG pattern also predicts imminent cardiac arrhythmia in other patient populations.
Keywords
MedicineBiochemistry, Genetics and Molecular Biology
Journal of the American College of CardiologyRight bundle branch block, persistent ST segment elevation and sudden cardiac death: A distinct clinical and electrocardiographic syndrome
3,325 Citations1992Pedro Brugada, Josép Brugada
Common clinical and ECG features define a distinct syndrome in this group of patients with recurrent episodes of aborted sudden death unexplainable by currently known diseases, not explainable by electrolyte disturbances, ischemia or structural heart disease.
NatureGenetic basis and molecular mechanism for idiopathic ventricular fibrillation
1,827 Citations1998Qiuyun Chen, Glenn E. Kirsch +16 more
It is shown that sodium channels with the missense mutation recover from inactivation more rapidly than normal and that the frameshift mutation causes the sodium channel to be non-functional.
CirculationCellular Basis for the Normal T Wave and the Electrocardiographic Manifestations of the Long-QT Syndrome
990 Citations1998Gan‐Xin Yan, Charles Antzelevitch
The authors' data suggest that the "pathophysiological U" wave observed in acquired or congenital LQTS is more likely to be a second component of an interrupted T wave, and argue for use of the term T2 in place of U to describe this event.
Circulation ResearchIonic Mechanisms Responsible for the Electrocardiographic Phenotype of the Brugada Syndrome Are Temperature Dependent
604 Citations1999Robert Dumaine, Jeffrey A. Towbin +7 more
The findings explain the features of the ECG of Brugada patients, illustrate for the first time a cardiac sodium channel mutation of which the arrhythmogenicity is revealed only at temperatures approaching the physiological range, and suggest that some patients may be more at risk during febrile states.
BMJMetabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports.
583 Citations1992Timothy J. Parke, John E. Stevens +6 more
Although the exact cause of death in these children could not be defined, propofol may have been a contributing factor.
Intensive Care MedicineThe pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome
564 Citations2003Beatrice Vasile, Frank Rasulo +2 more
The syndrome can be lethal and it is suggested caution when using prolonged (>48 h) propofol sedation at doses higher than 5 mg/kg per h, particularly in patients with acute neurological or inflammatory illnesses, and alternative sedative agents should be considered.
CirculationSodium Channel Block With Mexiletine Is Effective in Reducing Dispersion of Repolarization and Preventing Torsade de Pointes in LQT2 and LQT3 Models of the Long-QT Syndrome
529 Citations1997Wataru Shimizu, Charles Antzelevitch
The results suggest that although pacing and sodium channel block are very effective in abbreviating the QT interval and TDR in LQT3, these therapeutic approaches may also be valuable in reducing the incidence of arrhythmogenesis in L QT2.
CirculationCellular Basis for the ECG Features of the LQT1 Form of the Long-QT Syndrome
502 Citations1998Wataru Shimizu, Charles Antzelevitch
The data provide a mechanistic understanding of the cellular basis for the therapeutic actions of beta-adrenergic blockers in LQT1 and suggest that sodium channel block with class IB antiarrhythmic agents may be effective in suppressing TdP in L QT1.
The LancetLong-term propofol infusion and cardiac failure in adult head-injured patients
395 Citations2001Olaf L. Cremer, Karel G.M. Moons +4 more
It is suggested that propofol infusion at rates higher than 5 mg/kg per h should be discouraged for long-term sedation in the intensive-care unit.
European Heart JournalProposed Diagnostic Criteria for the Brugada Syndrome
328 Citations2002Arthur A.M. Wilde
In regions of Southeast Asia where it is endemic, the clinical presentation of Brugada syndrome is distinguished by a male predominance and the appearance of arrhythmic events at an average age of 40 years.
American Journal of Physiology-Heart and Circulatory PhysiologyI(to) and action potential notch are smaller in left vs. right canine ventricular epicardium
247 Citations1996José M. Di Diego, Zhuoqian Sun +1 more
The data point to prominent differences in the magnitude of the I(to) 1-mediated action potential notch in cells at the surface of RVE compared with the LVE and suggest that important distinctions may exist in the response of these two tissues to pharmacological agents and pathophysiological states.
CirculationRepolarizing K <sup>+</sup> Currents <i>I</i> <sub>TO1</sub> and <i>I</i> <sub>Ks</sub> Are Larger in Right Than Left Canine Ventricular Midmyocardium
216 Citations1999Paul G.A. Volders, Karin R. Sipido +4 more
Differences in K+ currents may well explain the interventricular heterogeneity of action potentials in M layers of the canine heart and contribute to a further phenotyping of the ventricular action potential under physiological conditions.
NeurologyRhabdomyolysis and hypoxia associated with prolonged propofol infusion in children
202 Citations1998Joseph P. Hanna, Maria Ramundo
It is suggested that propofol should not be used for prolonged sedation in children until its safety can be ensured.
Journal of the American College of CardiologyBrugada syndrome: 1992–2002
197 Citations2003Charles Antzelevitch, Pedro Brugada +4 more
The purpose of this brief review is to chronicle the historical highlights that have brought us to the present understanding of Brugada syndrome.
AnaesthesiaEvaluation of the predictive performance of a ‘Diprifusor’ TCI system
190 Citations1998C. F. Swinhoe, J.E. Peacock +2 more
The predictive performance of a ‘Diprifusor’ target controlled infusion system for propofol was examined in 46 patients undergoing major surgery, divided into three age groups (18–40, 41–55 and 56–80 years).
Critical Care MedicineComparison of propofol and midazolam for sedation in intensive care unit patients
176 Citations1995Kevin P. Ronan, T. James Gallagher +2 more
Propofol was as safe and as efficacious as midazolam for continuous intravenous sedation and the quality of sedation was better in the propofol-treated group.
Critical Care MedicinePropofol impairment of mitochondrial respiration in isolated perfused guinea pig hearts determined by reflectance spectroscopy
164 Citations2000Kenneth A. Schenkman, Shiluo Yan
Propofol impairs either oxygen utilization or inhibits electron flow along the mitochondrial electron transport chain in the guinea pig cardiomyocyte and significantly decreases ventricular performance in the isolated perfused heart.
AnesthesiologyModulation of Cardiac Calcium Channels by Propofol
149 Citations1997Weiguo Zhou, Jerrel H. Fontenot +2 more
It is suggested that propofol may inhibit cardiac L‐type calcium current by interacting with the dihydropyridine‐binding site and increasing the apparent dissociation constant for [sup 3 H]nitrendipine without affecting binding‐site density.
Journal of Cardiovascular ElectrophysiologyCellular Basis for Complex T Waves and Arrhythmic Activity Following Combined I<sub>Kr</sub> and I<sub>Ks</sub> Block
132 Citations2001Tetsuro Emori, Charles Antzelevitch
A growing number of cardiomyopathies have been shown to result in a reduction in both IKr and IKs, yet little is known about the electrophysiologic and ECG characteristics of combined IKR and Iks block.
Clinical ChemistryPropofol-associated Rhabdomyolysis with Cardiac Involvement in Adults: Chemical and Anatomic Findings
113 Citations2000Edward B. Stelow, Vandita Johari +3 more
Two adults who developed rhabdomyolysis after receiving high rates of propofol infusion are described, with marked increases of creatine kinase and cardiac troponin I suggested.
Journal of neurosurgeryMetabolic acidosis, rhabdomyolysis, and cardiovascular collapse after prolonged propofol infusion
88 Citations2001Michael L. Cannon, Steven S. Glazier +1 more
The authors present the hospital course of a 13-year-old girl with a closed head injury who received a prolonged infusion of propofol for sedation and, subsequently, died as a result of severe metabolic acidosis, rhabdomyolysis, and cardiovascular collapse.
Biochemical PharmacologyInfluence of the anesthetic 2,6-diisopropylphenol on the oxidative phosphorylation of isolated rat liver mitochondria
69 Citations1991Donata Branca, Michela S. Roberti +3 more
Findings suggest that under the experimental conditions reported 2,6-diisopropylphenol affected the generation and/or maintenance of the transmembrane electrical potential while leaving unchanged the coupling between the electron flow in the respiratory chain and the synthesis of ATP.
Anaesthesia and Intensive CarePropofol Infusion Syndrome— Report of an Adult Fatality
52 Citations2004D. Ernest, Craig French
This is the first published Australian case of the propofol infusion syndrome in an adult and should serve as an additional case report to the existing literature highlighting this potentially fatal syndrome in adults.
AnesthesiologyPropofol Attenuates β-Adrenoreceptor–mediated Signal Transduction via a Protein Kinase C–dependent Pathway in Cardiomyocytes
48 Citations2002Hiromi Kurokawa, Paul A. Murray +1 more
Clinically relevant concentrations of propofol attenuate &bgr;-adrenergic signal transduction in cardiac myocytes via inhibition of cAMP production.
CirculationEffect of graded coronary flow reduction on ionic, electrical, and mechanical indexes of ischemia in the pig.
46 Citations1987Isao Watanabe, Timothy A. Johnson +3 more
Results indicate that changes in [K+]e, pHe, and TQ-ST segment provide the most sensitive means of detecting myocardial ischemia and of determining the effect of interventions capable of influencing the ischemic process.
AnaesthesiaPropofol sedation using Diprifusor <sup>TM</sup> target‐controlled infusion in adult intensive care unit patients*
38 Citations2004T. J. McMurray, J. R. Johnston +6 more
Measured propofol concentrations were generally close to values predicted by the DiprifusorTM system and target settings in the range of 0.2–2.0 μg.ml−1 are proposed for prop ofol sedation in this setting with titration as required in individual patients.
AnesthesiologyPropofol-induced Depression of Cultured Rat Ventricular Myocytes Is Related to the M2-acetylcholine Receptor–NO–cGMP Signaling Pathway
28 Citations1999Shuji Yamamoto, Shin Kawana +3 more
The results suggest that the negative chronotropy induced by propofol is mediated in part by M2-acetylcholine receptor activation, which involves the enhancement of NO production in cultured rat ventricular myocytes.
The Journal of Membrane BiologyCytoplasmic acidosis induces multiple conductance states in ATP-sensitive potassium channels of cardiac myocytes
21 Citations1993Zheng Fan, Tetsushi Furukawa +3 more
The results suggest that protons bound to the negatively charged group at the inner entrance of the channel ion pore may induce conformational changes, leading to partially reduced conductance states.
American Journal of Physiology-Heart and Circulatory PhysiologyExtracellular pH modulates block of both sodium and calcium channels by nicardipine
11 Citations1990F. Roosevelt Gilliam, Padilla Rivas +3 more
The time constants of recovery of Na (INa) and Ca currents (ICa) recorded from rabbit atrial myocytes during control and exposure to the lipid-soluble Ca antagonist nicardipine as external pH was reduced are measured.
