Comparison Of Effects Of Different Of Anesthesia Methods On QT Interval In Patients Undergoing Radical Mastectomy After Anthracycline Chemotherapy

Objective To compare the effects and variation tendency ofpropofol and isoflurane influence on QT interval in the patients undergoing radical mastectomy after anthracycline chemotherapy.Aimed at exploring these two anesthetics on after neoadjuvant chemotherapy in patients with the influence degree of myocardial cells. Provide the theory basis in order to seek a more secure anaesthesia method for neoadjuvant chemotherapy patients.Methods Eighty ASAâ… orâ…¡patients,aged 28-64y,stageâ…¡orâ…¢breast cancer,weight 42-78 kg,scheduled for radical mastectomy under general anesthesia,were divided into 4 groups(n=20 each):group AI,group AP,group CI and group CP.The patients received neoadjuvant chemotherapy with cyclophosphamide-fluorouracil-anthracycline 4 cycle before radical mastectomy in group AI and AP.But the patients were not previously treated cyclophosphamide-fluorouracil-anthracycline in group CI and CP.Anesthesia was induced with midazolam 0.05 mg / kg,fentanyl 4μg / kg and etomidate 0.3 mg / kg tracheal intubation was facilitated with vecuronium 0.1 mg / kg.Anesthesia was maintained with 1.0%-1.5%isoflurane in group AI and CI,and propofol via TCI (target plasma concentration set at 1.8-2.0μg/ml) in group AP and CP.The end-tidal carbon dioxide partial pressure was maintained at 35-40mmHg(1 kPa = 7.5 mm Hg) by mechanically ventilation.QT interval and QT interval prolongation were recorded before chemotherapy(T1),at 2 weeks after chemotherapy(T2),immediately before tracheal intubation(T3),immediately after tracheal intubation(T4),at 5,10,15 and 30 min of inhalation of isoflurane or intravenous infusion of propofol(T5-8) and at 10 min after the tracheal intubation(T9).QT interval dispersion was calculated at T1-7. The left ventricular ejection fraction is measured in group AI and group AP before chemotherapy and in one week of the chemotherapy had finished.Blood sample were detected at T3,T5,T7,T9 for determination of plasma levels of K⁺ and Mg²⁺.Results QT interval was significantly longer at T6-8 in group AI than at T2.QT interval was significantly longer at T6-8 and QT interval dispersion longer at T5-7 in group AI than in group CI(p<0.05).The incidence of QT interval prologation was significantly higher in group AI than in group CI,AP and CP(p<0.05).There were no significant differences in QT interval and QT interval dispersion at each time point between group CP and AP and between group AI and AP(p>0.05).Conclusion Acceptance anthracycline neoadjuvant chemotherapy in breast cancer patients,QT dispersion increase.Isoflurane can further extend the breast cancer patient's QT interval and QT dispersion who accepted preoperative anthracycline antibiotics,propofol has no effect like isoflurane.Propofol combined with remifentanil anesthesia is better choice for the patients who pretreated with anthracycline and will undergoing radical mastectomy.