The management and outcome of documented intraoperative heart rate-related electrocardiographic changes. J Cardiothorac Vasc Anesth 2011 Oct;25(5):791-8
Date
07/05/2011Pubmed ID
21724417DOI
10.1053/j.jvca.2011.03.174Scopus ID
2-s2.0-80053570131 (requires institutional sign-in at Scopus site)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.
Author List
Hobai IA, Gauran C, Chitilian HV, Ehrenfeld JM, Levinson J, Sandberg WSAuthor
Jesse Ehrenfeld MD, MPH Sr Associate Dean, Director, Professor in the Advancing a Healthier Wisconsin Endowment department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdrenergic beta-Antagonists
Adult
Aged
Aged, 80 and over
Anesthesia
Blood Pressure
Bradycardia
Electrocardiography
Exercise Test
Female
Follow-Up Studies
Heart Rate
Humans
Hypotension
Intraoperative Complications
Male
Middle Aged
Monitoring, Intraoperative
Myocardial Infarction
Postoperative Complications
Retrospective Studies
Surgical Procedures, Operative
Treatment Outcome
