Observation of the effect of fentanyl on QTc value in patients administered intravenous fentanyl in the emergency department

Introduction : QT interval means the time elapsed from the beginning of the Q wave to the end of the T wave. Refers to the time taken for ventricular depolarization and repolarization. QT prolongation is associated with fatal dysrhythmias such as torsades de pointes, syncope and sudden death. Short QT, also recently described, is associated with an increased risk of paroxysmal atrial and ventricular fibrillation and sudden cardiac death. QT interval varies with heart rate; therefore it needs correction. The Bazzett formula is the most commonly used formula for correction. The QT interval between 360 and 420 milliseconds is normal, over 440 milliseconds in males, over 460 milliseconds in females are prolonged, less than 320 milliseconds is shortened in both genders. There are many factors that affect QTc and drugs are one of these groups. Studies showing the effect of fentanyl on QTc are not sufficient. It has been shown in some studies that it prolongs the QTc value and in some studies it shortens the QTc value. Some studies have shown that it does not affect QTc. Fentanyl, a drug commonly used in emergency services, is often used without knowing the baseline QTc value of the patients, without questioning the risk factors for their cardiac history and fatal arrhythmias. Our purpose of this study is to investigate the effect of fentanyl on QTc value. If QTc is affected, it is to assess how vital this effect is and to raise awareness about the drug in this regard. Fentanyl is frequently preferred by emergency medicine clinicians as an analgesic drug, has a risk of death if it affects QTc; while fentanyl was administered as a single drug, the absence of another study in which other drugs were unlikely to affect the QTC value and the fact that it was the first study conducted in emergency medicine clinics led us to do this study. Materials and Methods : This study is a prospective observational drug study. 109 patients were included in the study by the researcher physician by questioning the exclusion criteria (electrolyte imbalance, comorbidity, drug use affecting Qtc, drug administration in the emergency service ...) for patients who were decided to administer fentanyl by their physicians in the emergency department. In 100 cc isotonic fluid, 1 mcg / kg fentanyl was administered as an intravenous infusion within 5 minutes. These patients were monitored for 60 minutes, and their ECGs were taken at 0, 1, 5, 15, 30 and 60 minutes, and their QTc values were calculated by the device and manually verified from leads D2 and V5-6. No medication was administered to these patients in the emergency department during this period and before. QTc value, over 440 msec in males, over 460 msec in females are prolonged; over 500 msec for both genders and increase over 60 ms at any time was accepted as the cut-off value for the development of malignant arrhythmia. Result : Fentanyl significantly prolongs the QTc value. The maximum elongation was determined between the initial value and the 30th minute and was calculated as 13.08 ms. When we examine the baseline values, the QTc value in women is longer than in men, and the QTc value increases with age. However, the expected direct increase with age could not be detected after fentanyl administration. QTc values were found 500 msec and above in 6 people. Only one of these patients was male (most people are in the 40-49 age range), the other 5 were female (most people are in the50-59 age range). QTc value increase was found 60 msec or more in 27 people. 10 patients were male (most people are in the40-49 age range), 17 patients were female (most people are in the 50-59 age range). It has been observed that the female gender is dominant in patients who exceed the cut-off values. Conclusion : Our study reveals that fentanyl prolongs the QTc value. Especially female gender and patients over the age of 40 constitute the majority of the patient population who exceed the critical threshold. Patients who is exceeding the cut-off risk for developing clinically significant malignant arrhythmias constitute 1/3 of the population included in the study and this should not be underestimated. Although we excluded situations that may affect the QTc value such as electrolyte imbalance, congenital long QT disease, coronary artery disease, and additional drug use in the patient group included in the study, the rate was determined as 1/3; It will be calculated much higher in the presence of conditions that may predispose to the underlying QTc prolongation. For this reason, we recommend that clinicians who will administer fentanyl be more careful.