The management and outcome of documented intraoperative heart rate-related electrocardiographic changes.

Abstract

OBJECTIVES:

The authors analyzed surgical cases in which electrocardiographic (ECG) signs of cardiac ischemia were noted to be precipitated by increases in heart rate (ie, heart rate-related ECG changes [REC]). The authors aimed to find REC incidence, specificity for coronary artery disease (CAD), and the outcome associated with different management strategies.

DESIGN:

A retrospective review.

SETTING:

A university hospital, tertiary care.

PARTICIPANTS:

Patients undergoing surgery under anesthesia.

INTERVENTIONS:

A chart review.

MEASUREMENTS:

The authors searched 158,252 anesthesia electronic records for comments noting REC (ie, ST-segment or T-wave changes). After excluding cases with potentially confounding conditions (eg, hypotension, hyperkalemia, and so on), 26 cases were analyzed.

RESULTS:

REC commonly was precipitated by anesthesia-related events (ie, intubation, extubation, and treatment of bradycardia). In 24 cases, REC was managed by prompt heart rate reduction using β-blocker agents, opioids, and/or cardioversion in the addition to the removal of stimulus. Only 1 case had a copy of the ECG printed. Two cases were aborted, 1 was shortened and 23 proceeded without change. Postoperative troponin T levels were checked, and cardiology consultation was obtained in selected cases and led to further cardiac evaluation in 6 cases. Postoperative myocardial infarction developed in only 1 patient in whom the ECG changes were allowed to persist throughout the case.

CONCLUSIONS:

This incidence of reported REC was much lower than the previously reported incidence of ischemia-related ECG changes, suggesting that the largest proportion of events go unnoticed. In many patients, subsequent cardiology workup did not confirm the existence of clinically significant CAD.

• Authors: Ion A Hobai, Cosmin Gauran, Hovig V Chitilian, Jesse M Ehrenfeld, John Levinson, Warren S Sandberg
• Journal: Journal of cardiothoracic and vascular anesthesia (J Cardiothorac Vasc Anesth) Vol. 25 Issue 5 Pg. 791-8 (Oct 2011) ISSN: 1532-8422 [Electronic] United States
• PMID: 21724417 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2011 Elsevier Inc. All rights reserved.

Chemical References

• Adrenergic beta-Antagonists

Topics

• Adolescent
• Adrenergic beta-Antagonists (therapeutic use)
• Adult
• Aged
• Aged, 80 and over
• Anesthesia
• Blood Pressure (physiology)
• Bradycardia (complications, therapy)
• Electrocardiography
• Exercise Test
• Female
• Follow-Up Studies
• Heart Rate (physiology)
• Humans
• Hypotension (complications, therapy)
• Intraoperative Complications (epidemiology, mortality, therapy)
• Male
• Middle Aged
• Monitoring, Intraoperative
• Myocardial Infarction (diagnosis, mortality, therapy)
• Postoperative Complications (therapy)
• Retrospective Studies
• Surgical Procedures, Operative (methods)
• Treatment Outcome