Effect of Methadone and Hydromorphone on the QT Interval After Anesthesia and Surgery
Status:
Unknown status
Trial end date:
2020-12-23
Target enrollment:
Participant gender:
Summary
A number of drugs used in the perioperative period may cause prolongation of the QT interval
on the electrocardiogram (EKG). These drugs include inhalational agents, antiemetic agents,
pain medications, and drugs used to reverse the effects of muscle relaxants. Approximately
80% of patients undergoing a general anesthetic will demonstrate significant prolongation of
the QT interval on the EKG in the postanesthesia care unit (PACU) following surgery. The
concern with QT interval prolongation is that it can result in a potentially lethal
ventricular arrhythmia termed torsade des pointes. Despite the concurrent use of several of
these medications in a typical general anesthetic, torsade des pointes is a rare event in the
perioperative period. In the past decade, the use of intravenous methadone as part of a
balanced anesthetic technique has increased significantly. A single dose provided at
induction of anesthesia can provide prolonged (24-48 hours) relief from pain. Studies in
patients receiving long-term treatment with methadone for addiction therapy or chronic pain
have revealed that these patients are at risk for QT prolongation, torsade des pointe, and
cardiac death. However, the effect of a single intravenous dose of methadone used in the
operating room on the QT interval is uncertain. The aim of this randomized clinical trial is
to compare the impact of methadone, when compared to the more commonly-used opioid
hydromorphone, on QT prolongation measured with a 12-lead EKG in the PACU and on
postoperative day 1. We hypothesize that methadone will not result in significant QT
prolongation when used as part of a standardized general anesthetic.
Phase:
Phase 4
Details
Lead Sponsor:
NorthShore University HealthSystem NorthShore University HealthSystem Research Institute