A 34yo patient is booked for thyroidectomy for cancer. She has chronic mental health issues (schizophrenia & anxiety) on multiple antipsychotic therapies including clozapine and haloperidol. Currently she is stable from a mental health point of view. Noted on EGC to have a prolonged QTc (0.567) but is otherwise well. EGC in 2012 did not show prolonged QTc on the same dose. Is it appropriate to change medication?
Discussion: – The stability of the mental health management is important to maintain. There is some urgency in the surgery. Therefore it is appropriate to proceed and maintain the MH therapies. It may be useful to have beta blockers or prophylactic magnesium available, but it would generally be reasonable to proceed carefully. The psychiatrist should be notified to consider reviewing the medication post operatively. (Cardiologists agreed).
REF Booker PD, Whyte SD, Ladusans EJ. Long QT syndrome and anaesthesia Brit J Anaes 2003:90 (3): 349-66
Perioperative Talk 