[Comparison of electrocardiographic parameters during pneumoperitoneum in patients without cardiovascular diseases and in patients with ischemic heart disease].

Kauno medicinos universiteto Anesteziologijos klinika, Eiveniu 2, 3007 Kaunas.
Medicina (Kaunas, Lithuania) (Impact Factor: 0.49). 02/2002; 38(2):197-204.
Source: PubMed


Pneumoperitoneum induces significant pathophysiological changes. Changes in performance of cardiovascular system can be severe in patients with compromised cardiac function. Groups of patients to whom these changes may be deleterious are yet to be identified. Aim of the study was to elucidate the influence of pneumoperitoneum on the electrocardiographic recording.
35 cardiovascular healthy (ASA I-II) patients (group 1) and 34 patients with underlying moderate ischemic heart disease (ASA II-IV, Goldman's cardiac risk class II-III) (group 2), scheduled for elective laparoscopic cholecystectomy, were included in the study. Premedication included sedatives for all patients and the group 2 received their usual cardiovascular treatment one hour before operation. A standardized protocol of monitoring and anesthesia was followed in the operating room. 12 lead electrocardiograms (ECG) were obtained before and after induction of anesthesia, every 10 minutes during pneumoperitoneum, after the peritoneal desufflation and after extubation. The ECGs were recorded and analysed by the means of computerized system for ECG record and analysis "Kaunas" (UAB "Kardiosignalas", Kaunas, Lithuania). The analysis was performed postoperatively.
During pneumoperitoneum a deviation of cardiac electrical axis to the left was observed. There were no marked changes in duration of P wave, P-Q interval, and QRS complex. Following abdominal insufflation a tendency to flattening of T wave was observed returning to the initial position after desufflation. No significant dislocation of ST segment was recorded.
The pneumoperitoneum induced changes of cardiac electrical axis can affect the interpretation of ECG seen on a cardiac monitor during anesthesia. Pneumoperitoneum does not pose patients with moderate ischemic heart disease at additional risk of developing myocardial ischemia.

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    ABSTRACT: Induction of pneumoperitoneum (PP) may lead to adverse cardiac functions secondary to changes such as decreased venous return and hypercarbia. The assessment of cardiac electrical activity by signal averaging may reflect various hemodynamic derangements and serve as a prognostic marker for arrhythmias. The aim of the study is to examine characteristic electrocardiographic changes that may occur during PP, by using signal-averaged P-wave analysis. Twenty healthy (ASA I and II) patients were enrolled in a prospective paired control study, and underwent elective laparoscopic cholecystectomy. A standard ECG together with computerized filtered signal-averaged P-wave duration measurement (leads X, Y, Z) were carried out during awareness, under anesthesia before and during PP, and after CO(2) evacuation. Depth of anesthesia was controlled by bi-spectral index (BIS). An increased duration of P-wave was observed during PP in comparison to the anesthesia phase before PP (111 versus 115 ms, t-test and Wilcoxon signed rank test). A significant increase was also detected in the maximal value of P-wave duration between these phases of the operation. The difference in the number of patients in whom the duration increased by at least 5 ms was also found to be significant. Primarily, a decreased P-wave duration was expected, due to cardiac autonomic sympathetic predominance during PP. Its prolongation during PP may reflect some cardiac pathophysiological (structural and functional) changes, including influence on cardiac ion channels during depolarization. Usually, clinical consequences related to laparoscopic cholecystectomy are absent, but clinical awareness should be maintained for cardiac diseased patients undergoing prolonged laparoscopic procedures.
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