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Effect of ramosetron on QTc interval: a randomised controlled trial in patients undergoing off-pump coronary artery bypass surgery.

ABSTRACT: Ramosetron is a relatively new 5-hydroxytryptamine three receptor antagonist with higher binding affinity and more prolonged duration of action compared to ondansetron. The present study was performed to evaluate the effects of ramosetron on QTc interval and possible cardiovascular adverse effects in patients undergoing cardiac surgery.A total of 114 patients who underwent off-pump coronary artery bypass surgery were enrolled in this randomised placebo-controlled trial. Patients were allocated into two groups that received intravenous injection of 0.3 mg ramosetron or normal saline during induction of anaesthesia. QTc intervals were measured before the operation, intraoperatively (0, 1, 2, 3, 5, 10, 15, 30, 45, 60, 90, 120, and 240 min after injection of ramosetron or normal saline), at the end of the operation, and on postoperative day 1.There were no differences in mean QTc interval between groups at every time point. However, maximal change in QTc interval during surgery was higher in the ramosetron group than the placebo group (25.1?±?22.0 vs. 17.5?±?14.5 ms, 95 % CI 0.34-14.78, P?=?0.040). Also, there were more patients with a QTc interval increase of?>?60 ms in the ramosetron group (5 vs. 0, 95 % CI 1.6-18.0, P?=?0.021). There were no significant differences in cardiovascular complications.Ramosetron administered during induction of anaesthesia may affect maximal change in QTc interval during off-pump coronary artery bypass surgery. Ramosetron should be used with caution in high risk patients for developing Torsades de Pointes.ClinicalTrials.gov NCT02139241. Registered November 12, 2013.

SUBMITTER: Kim TK

PROVIDER: S-EPMC4972982 | biostudies-literature | 2016 Aug

REPOSITORIES: biostudies-literature

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Effect of ramosetron on QTc interval: a randomised controlled trial in patients undergoing off-pump coronary artery bypass surgery.

Kim Tae Kyong TK Cho Youn Joung YJ Lim Chae-Won CW Min Jeong Jin JJ Choi Eue-Keun EK Hong Deok Man DM Jeon Yunseok Y

BMC anesthesiology 20160803 1

<h4>Background</h4>Ramosetron is a relatively new 5-hydroxytryptamine three receptor antagonist with higher binding affinity and more prolonged duration of action compared to ondansetron. The present study was performed to evaluate the effects of ramosetron on QTc interval and possible cardiovascular adverse effects in patients undergoing cardiac surgery.<h4>Method</h4>A total of 114 patients who underwent off-pump coronary artery bypass surgery were enrolled in this randomised placebo-controlle ...[more]

PMID: 27488394

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Project description:ContextLeft ventricle diastolic dysfunction (LVDD) is gaining importance as useful marker of mortality and morbidity in cardiac surgical patients. Different algorithms have been proposed for the intraoperative grading of DD. Knowledge of the particular grade of DD has clinical implications with the potential to modify therapy, but there is a paucity of literature on the role of diastolic function evaluation during off-pump coronary artery bypass grafting (OPCABG) surgery.AimsThe aim of this study was to monitor changes in LVDD using simplified algorithm proposed by Swaminathan et al. in patients undergoing OPCABG.Settings and designThe study was conducted in a tertiary care level hospital; this was a prospective, observational study.Subjects and methodsFifty consecutive patients undergoing OPCABG were enrolled. Hemodynamic and echocardiographic parameters were measured at 6 stages in every patient namely after anesthetic induction (baseline), during left internal mammary artery (LIMA) to left anterior descending (LAD) grafting (LIMA ? LAD), saphenous vein graft (SVG) to obtuse marginal (OM) grafting (SVG ? OM), SVG to posterior descending artery (PDA) grafting (SVG ? PDA), during proximal anastomosis of SVG to aorta, and postprotamine. The patients were classified in grades of LVDD as per simplified algorithm proposed by Swaminathan et al. using only intraoperatively measured E and E'.ResultsThe success rate of measurement and classification of LVDD was 98.92% (277 out of 280 measurements). The grades of LVDD varied significantly as per surgical steps with maximum downgrading occurring during OM and LAD grafting. During OM grafting, none of the patients had normal diastolic function while 29% of patients exhibited restrictive pattern (Grade 3 LVDD). Patients with normal baseline LV diastolic function also exhibited downgrading during OM and LAD grafting. Postprotamine, 37% of patients with normal baseline diastolic function continued to exhibit some degree of DD.ConclusionsThe LVDD changes dynamically during various stages of OPCABG, which can be successfully monitored with simplified algorithm.

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Effect of ramosetron on QTc interval: a randomised controlled trial in patients undergoing off-pump coronary artery bypass surgery.

Publications

Effect of ramosetron on QTc interval: a randomised controlled trial in patients undergoing off-pump coronary artery bypass surgery.

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