QTc changes in elderly patients: a comparison of spinal and general anesthesia

Background: Prolongation of the corrected QT (QTc) interval is associated with an elevated risk of ventricular arrhythmias and sudden cardiac death. Both spinal and general anesthesia are known to influence QTc duration; however, their differential effects in elderly patients remain inadequately defined. Methods: This prospective randomized study evaluated QTc interval changes in patients aged over 65 years undergoing elective surgery under either spinal or general anesthesia. QTc intervals were measured at multiple perioperative time points and compared within and between groups. General anesthesia was maintained with sevoflurane, while spinal anesthesia was administered using hyperbaric bupivacaine. Results: No intraoperative QTc prolongation was observed in either group. In the early postoperative period, the general anesthesia group showed a significant increase in QTc compared to baseline (432 ± 24 ms vs. 443 ± 29 ms, p = 0.023), whereas the spinal group exhibited no such change (427 ± 24 ms vs. 425 ± 28 ms, p = 0.974). Despite this, postoperative QTc values were significantly higher in the spinal anesthesia group compared to the general anesthesia group (p = 0.019). Conclusions: General anesthesia with sevoflurane may contribute to postoperative QTc prolongation in elderly patients, whereas spinal anesthesia appears not to exert such an effect. Spinal anesthesia may thus be preferable for patients with heightened arrhythmia risk. Clinical Trial Registration: This study was registered at ClinicalTrials.gov (NCT06375863).

Spinal anesthesia; General anesthesia; Sevoflurane; Electrocardiography; QTc interval

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