Prolonged QTc Interval Clinical Trial
Official title:
Comparative Electrocardiographic Effects of Intravenous Ondansetron and Granisetron in Patients Undergoing Surgery for Carcinoma Breast: A Prospective Single Blind Randomised Trial
Postoperative nausea and vomiting [PONV] are common and distressing symptoms after surgery performed under general anaesthesia. 5HT3 antagonists are routinely used for prevention as well as treatment of PONV. After IRB approval we compared the effects of ondansetron and granisetron on the various intervals on ECG in 70 patients undergoing elective surgery for carcinoma breast after written informed consent. The demographic data was collected. The administration of the anaesthetic was left to the discretion of the operating room staff specialist. In the Postoperative Recovery Room patients were randomised to receive 8 mgs of ondansetron or 1 mg of granisetron intravenously. Serial ECGs were recorded at 0 mins (before injection of study drug), 2 mins, 5 mins, 15mins, 1 hour and 2 hours. Pulse rate, Non-invasive blood pressure and SpO2 were also recorded. T
This prospective, randomized, single blind study was conducted after our Institutional
Review Board approved the study protocol, consent form and the randomization form. 70
consecutive ASA I-III patients (age18 to 60 years) undergoing breast surgery for carcinoma
breast were included in the study after obtaining written informed consent. Patients
refusing consent, with prolonged QTc interval, with arrhythmias or conduction defects and
those with abnormal serum levels of potassium, calcium, magnesium were excluded. There was
no standardized anaesthesia technique. The technique of induction of anaesthesia,
maintenance and reversal of anaesthesia was left to the discretion of the staff anaesthetist
in the operating theatre. The data on comorbidities, preoperative medications for the
comorbidities, premedication, induction agents, analgesics, muscle relaxants and inhalation
agents was collected.
Sample size calculation: A sample size calculation was performed [according to mean changes
(difference of means) in QTc interval] to find out the number of patients needed to find a
significant difference between the two drugs. To detect a QTc change from baseline of
greater than 5 ms with α and β error of 0.05 and 0.20, respectively, and assuming an SD of
QTc change of 10 ms using a one-sided test, a minimum of 35 subjects were needed in each
antiemetic group.
Randomization: The patients (n= 70) were divided randomly in two groups by computer
generated random numbers by the statisticians in the Clinical Research Secretariat (CRS) in
our institute. Block randomization was done with blocks of 10, to allow stratification of
the patients depending on whether they had received anthracycline based neoadjuvant
chemotherapy. The list of randomization numbers and clinical details were maintained in the
CRS.
Intervention: Once the patients arrived postoperatively in the recovery room, one of the
investigators called the Clinical Research Secretariat (CRS) on phone, after completing the
randomization form and gave the patient details. The Statistician allocated the drug the
patient should receive which was prepared by the investigator which was either ondansetron 8
mg (Group O) or granisetron 1mg (Group G). A baseline 12 lead electrocardiogram was obtained
before the drug was administered. After baseline ECG, patients in Group O were given
intravenous 8 mg ondansetron and patients in group G were given 1 mg granisetron over 30
seconds. Subsequently serial 12 lead ECGs were done at 2 mins, 5 mins, 15mins, 1 hour and 2
hours. Pulse, blood pressure and SpO2 were also monitored at those intervals. Unfiltered
Electrocardiograms were recorded at paper speed of 25mm/sec and at normal amplitude with a
HP Vigilent Pagewriter 100TM device which automatically calculates and prints the heart rate
and the duration of various ECG intervals. The investigators independently read and analyzed
the ECG to confirm that the intervals obtained with the ECG machine were indeed accurate. QT
and R-R intervals were measured for calculation of corrected QT (QTc) interval. The
corrected QT (QTc) interval was calculated by using the formula described by Bezzet. [QTc =
QT interval/√ (RR interval)]
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Allocation: Randomized, Endpoint Classification: Safety Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Subject), Primary Purpose: Treatment
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