Journal Article

In-hospital haloperidol use and perioperative changes in QTc-duration

de Rooij, S.E., Tan, H.L., van der Velde, Nathalie, Blom, M.T., Jansen, S., van Munster, B.C., de Boer, A., de Jonghe, A.

2015

Overview

Haloperidol may prolong ECG QTc-duration but is often prescribed perioperatively to hip-fracture patients. We aimed to determine (1) how QTc-duration changes perioperatively, (2) whether low-dose haloperidol-use influences these changes, and (3) which clinical variables are associated with potentially dangerous perioperative QTc-prolongation (PD-QTc; increase >50 ms or to >500 ms). Prospective cohort study. Tertiary university teaching-hospital. Patients enrolled in a randomized controlled clinical trial of melatonin versus placebo on occurrence of delirium in hip-fracture patients. Data from ECGs made before and after hip surgery (1–3 days and/or 4–6 days post-surgery) were analyzed. QTc-duration was measured by hand, blinded for haloperidol and pre/post-surgery status. Clinical variables were measured at baseline. Mixed model analysis was used to estimate changes in QTc-duration. Risk-factors for PD-QTc were estimated by logistic regression analysis. We included 89 patients (mean age 84 years, 24% male); 39 were treated with haloperidol. Patients with normal pre-surgery QTc-duration (male ≤430 ms, female ≤450 ms) had a significant increase (mean 12 ms, SD 28) in QTc-duration. A significant decrease (mean 19 ms, SD 34) occurred in patients with prolonged pre-surgery QTc-duration (male >450ms, female >470 ms). Haloperidol-use did not influence the perioperative course of the QTc-interval (p=0.351). PD-QTc (n=8) was not associated with any of the measured risk-factors. QTc-duration changed differentially, increasing in patients with normal, but decreasing in patients with abnormal baseline QTc-duration. PD-QTc was not associated with haloperidol-use or other risk-factors. Low-dose oral haloperidol did not affect perioperative QTc-interval.

• Publisher: Elsevier Masson SAS,Springer Paris,Springer Nature B.V
• Subject: Aged, 80 and over / Aging / Antipsychotic Agents - administration & dosage / Antipsychotic Agents - pharmacology / Cardiac arrhythmia / Cardiology / clinical trials / Cohort Studies / Comorbidity / Delirium / Delirium - complications / Delirium - drug therapy / Drug dosages / electrocardiography / Electrocardiography - drug effects / Female / females / Fractures / Geriatrics / Geriatrics/Gerontology / haloperidol / Haloperidol - administration & dosage / Haloperidol - pharmacology / Hip Fractures - complications / Hip Fractures - surgery / Hospitals / Humans / Internal medicine / Male / males / Medicine / Medicine & Public Health / Melatonin / Melatonin - therapeutic use / Neurosciences / Nutrition / Patients / Perioperative Period / placebos / Potassium / Primary Care Medicine / Prospective Studies / QTc-prolongation / Quality of Life Research / regression analysis / Risk Factors / Single-Blind Method / statistical models / Surgery