Anesthesia for children with long QT syndrome: Challenges and solutions from pediatric studies

Abstract

Background: The overall prevalence of Long QT syndrome (LQTS) is as high as 1 in every 2534 live births which exceeds few common genetic-bound anesthesia related disorders. Given less attention than even the rarer malignant hyperthermia, LQTS incidence is expected to be much higher during anesthesia and surgery for very reasons that they contribute to acquired LQTS. Thus, confined to original researches on pediatric patients, the aim of this review was to assess challenges and solution of LQTS during pediatric anesthesia. Methods: and finding: Seventeen studies conducted on pediatric population from Medline and Google scholar search results were finally analyzed. The review protocol was registered in PROSPERO. Assuming that whatever observed in adult researches may not apply for children; we included individual studies carried out just on children. Shortage of purely pediatric researches about LQTS was observed. Widely used in the literature, prolonged QT interval was employed as predictor of LQTS in this review. Narrative approach was used to analyze results. Preoperative anxiety and seizure are risk factors for LQTS. Whereas propofol and halothane shorten QT interval and can be used to treat LQTS; most of inhalational agents and few adjuvant drugs prolong QT interval and predispose children to the syndrome. Beta blockers and magnesium sulphate were effectively used to treat long QT syndrome perioperatively. Conclusion: LQTS worth emphasis as the prevalence and associated complications exceed some commonly discussed genetic disorders in anesthesia. Preoperative evaluation of pediatric patients directed to identifying perioperative risk factors and preparation for respective management minimizes potentially fatal complications associated with long QT syndrome.