QT interval and QT dispersion increase in the elderly during laparoscopic cholecystectomy: a preliminary study

Intra-abdominal hypertension and reverse Trendelenburg position increase frontal QRS-T angle in laparoscopic cholecystectomy: An observational study

Increased intra-abdominal pressure during laparoscopic surgery, anesthesia, patient position, and neuroendocrine response may increase the risk of arrhythmia. This study aimed to investigate the perioperative changes in the frontal QRS-T angle in patients undergoing laparoscopic cholecystectomy under general anesthesia. Therefore, electrophysiological parameters at different stages of laparoscopic cholecystectomy were studied using the frontal QRS-T angle and the risk of arrhythmia susceptibility was investigated. This prospective observational study included 48 patients aged 23 to 65 years with an American Society of Anesthesiologists score of 1 to 3 who underwent laparoscopic cholecystectomy in the operating room of Gaziosmanpaşa University Research and Application Hospital. Electrocardiographic recordings were obtained immediately before surgery, immediately before and after intra-abdominal carbon dioxide insufflation, 2 minutes after reverse Trendelenburg, immediately after extubation, and 2 hours postoperatively, and the frontal plane QRS-T angle, QT and QTc interval were studied. Rhythm disturbances, bleeding and complications were recorded. The frontal QRS-T angle, QT and QTc interval were significantly increased with intra-abdominal hypertension (IAH) compared to baseline (P < .001, P < .001, P < .001, respectively). Similarly, frontal QRS-T angle, QT, and QTc interval increased significantly with reverse Trendelenburg position compared to baseline (P < .001, P < .001, P < .001, respectively). The frontal QRS-T angle, which increased with IAH and the reverse Trendelenburg position, significantly decreased immediately after the patient woke up (P < .001). Heart rate and mean arterial pressure increased significantly with IAH compared to those just before carbon dioxide insufflation (P = .03, P < .001, respectively). The present study found that IAH induction and reverse Trendelenburg positioning increased the frontal QRS-T angle, QT, and QTc interval in patients undergoing laparoscopic cholecystectomy. These prolonged values may cause serious arrhythmias, particularly in patients with cardiac disease. Therefore, it is very important for anesthetists to be aware of electrocardiographic changes such as arrhythmias in patients undergoing laparoscopic cholecystectomy.

Electrocardiographic Early Changes After Abdominoplasty

INTRODUCTION

Abdominoplasty aims to reduce the abdominal excess tissue and tighten the abdominal wall. The tightening of the abdominal wall has structural and habitual consequences on the body, which might have an early effect on electrocardiography (ECG) of the patients through volumetric and pressure changes in thoracic and abdominal cavities. ECG serves as a diagnostic tool for assessing cardiac electrical conductions in routine clinical practice. In this study, we aimed to examine whether abdominoplasty has any discernible effect on early ECG results, with the goal of assessing potential cardiological benefits for the patients undergoing this procedure by comparing pre- and early postoperative ECGs.

METHOD

Study population included 49 patients who had abdominoplasty. ECG records before the procedure and 12-24 h after the surgery were analyzed retrospectively. Patients had no known cardiac diseases and did not have any diagnosed arrhythmia.

RESULTS

The mean age of the study population was 37.1 ± 8.5. The mean body mass index of the study population was 26.4. The mean weight of total removed abdominal skin tissue was 1057 grams. There were significant changes in ECG of the patients postoperatively. Heart rate was increased, and significant change was found in QRS axis (p < 0.001) and T wave axis (p < 0.001). Atrial conduction parameters such as PR duration (p  < 0.001), Pmax duration (p  =  0.001) and P-wave dispersion (p = 0.003) were significantly changed postoperatively. Ventricular conduction parameters such as QRS duration (p = 0.029), QT interval (p   < 0.001), QTc (p  < 0.001), TPe duration (p < 0.001), TPe / QT (p < 0.001) and TPe / QTc (p < 0.001) ratios were found significantly changed.

CONCLUSION

Abdominoplasty changes the intra-abdominal pressure in the first 24 h after the surgery, which may impact cardiac conduction. The understanding and recognition of possible early ECG changes is crucial during postoperative follow-up of the patients who undergo abdominoplasty surgery.

LEVEL OF EVIDENCE I

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The relationship between gestational week and QT dispersion in cesarean section patients undergoing spinal anaesthesia: A prospective study

BACKGROUND

Pregnancy affects the cardiovascular system, particularly the cardiac conduction system, thereby increasing the susceptibility of patients towards arrhythmia. QT interval results in ventricular arrhythmias, predominantly polymorphic ventricular tachycardia. The present study was planned to investigate the relationship between a gestational week and QT dispersion in cesarean section patients undergoing spinal anaesthesia.

METHODS

The study included 40 patients between the ages of 18 and 45 who had no symptoms of anaemia and undergoing elective cesarean section. The patients were separated into two groups based on the gestational week as Group I <39 weeks and Group II ≥39 weeks. The patient was given a sitting position and the puncture site was cleansed with 10% povidone-iodine antiseptic solution. After placing a sterile drape on the patient, the subarachnoid space was punctured through an appropriate vertebral space (L3-L4 or L4-L5) using a pencil-point 25G spinal needle, followed by intrathecal injection of 12.5 mg (2.5 mL) 5% hyperbaric bupivacaine hydrochloride. Electrocardiographic (ECG) records were obtained both preoperatively and at 1, 5, and 10 minutes after spinal block, and the QT, QTc, QTd, and corrected QTd (QTcd) intervals were estimated using Bazett's formula.

RESULTS

There was no significant difference between the two groups within the QT and QTc intervals. QTcd measured after post-operative was significantly higher in Group II (P = .007).

CONCLUSION

The results indicated that spinal anaesthesia may prolong the QTdc interval in patients with a gestational week of ≥39 weeks undergoing cesarean section.

Effect of different general anaesthetics on ventricular repolarisation in robot-assisted laparoscopic prostatectomy

BACKGROUND

Ventricular repolarisation is affected differently by the types of anaesthetics used. This study aimed to compare the effect of different types of anaesthetics on ventricular repolarisation during robot-assisted laparoscopic radical prostatectomy (RALP).

METHODS

Sixty-nine patients were randomly assigned in a 1:1:1 ratio to the Sevoflurane (sevoflurane/remifentanil), Desflurane (desflurane/remifentanil) or total intravenous anaesthesia (TIVA [propofol/remifentanil]) groups; however, only 67 patients completed the study. The primary outcome was heart rate-corrected QT (QTc) interval collected at nine time points during RALP. Bazett's (QTcB) and Fridericia's (QTcF) formulae were used for QT interval correction. The secondary outcomes were Tpeak-Tend (Tp-e) interval and Tp-e/QT ratio that were collected at the same time points.

RESULTS

The QTcB and QTcF intervals were significantly prolonged during surgery in all groups; however, these values showed significant intergroup differences with time. After assuming the Trendelenburg position, the QTcB and QTcF intervals were significantly longer in the Desflurane group than in the other two groups, and this prolongation continued until the end of surgery. Intra-operatively, the QTcB and QTcF intervals exceeded 450 ms in six and five patients, respectively, in the Desflurane group, but in none in the TIVA group. Moreover, the incidence of intra-operative QTc interval prolongation >20 ms and >60 ms was significantly higher in the Desflurane group than in the TIVA group. There were no significant differences in Tp-e intervals and Tp-e/QT ratio among the three groups during surgery.

CONCLUSIONS

To minimise QTc interval prolongation during RALP, TIVA with propofol/remifentanil is recommended for general anaesthesia.

Effects of long periods of pneumoperitoneum combined with the head-up position on heart rate-corrected QT interval during robotic gastrectomy: an observational study

Objective

Pneumoperitoneum and the head-up position reportedly stimulate the sympathetic nervous system, potentially increasing the risk of cardiac arrhythmia. We evaluated the effects of a long duration of pneumoperitoneum in the head-up position on the heart rate-corrected QT (QTc) interval during robotic gastrectomy.

Methods

This prospective observational study involved 28 patients undergoing robotic gastrectomy. The QTc interval was recorded at the following time points: before anaesthetic induction (baseline); 10 minutes after tracheal intubation; 1, 5, 30, 60, and 90 minutes after pneumoperitoneum induction in the head-up position; after pneumoperitoneum desufflation in the supine position; and at the end of surgery. The primary outcome was the QTc interval, which was measured 90 minutes after pneumoperitoneum combined with the head-up position.

Results

Compared with baseline, the QTc interval was significantly prolonged at 1 and 60 minutes after pneumoperitoneum, peaked at 90 minutes, and was sustained and notably prolonged until the end of surgery. However, no considerable haemodynamic changes developed.

Conclusion

A long period of carbon dioxide pneumoperitoneum application in a head-up position significantly prolonged the QTc interval during robotic gastrectomy. Therefore, diligent care and close monitoring are required for patients who are susceptible to developing ventricular arrhythmia.

Trial Registration: Registered at ClinicalTrials.gov; https://clinicaltrials.gov/ct2/show/NCT02604979; Registration number NCT02604979

Changes in spatial QRS-T angle and QTc interval in patients with traumatic brain injury with or without intra-abdominal hypertension

INTRODUCTION

Traumatic brain injury (TBI) affects cardiac electrical function, and several extra-cerebral factors, including intra-abdominal pressure (IAP), might further modulate this brain-heart interaction. The purpose of this study was to investigate the impact of TBI, and of increased IAP during TBI, on cardiac electrical function as measured by vectorcardiographic (VCG) variables.

METHODS

Survival, IAP and changes in VCG variables including spatial QRS-T angle and QTc interval were measured in consecutive adult patients with either isolated TBI (iTBI), or with TBI accompanied by polytrauma to the abdomen and/or limbs (pTBI). For all patients, observations were performed just after the admission to the ICU (baseline) and at 24, 48, 72 and 96 h after admission.

RESULTS

74 patients aged 45 ± 18 were studied. 44 were treated for iTBI and 30 for pTBI. In all patients, spatial QRS-T angle and QTc interval increased after TBI (p < 0.001), relatively more so in patients with pTBI. Compared to survivors, non-survivors also ultimately had greater widening of the spatial QRS-T angle (p < 0.001), most notably just before foraminal herniation. Wider spatial QRS-T angle and longer QTc interval were also noted in patients with IAP > 12 mmHg (p < 0.001), and with right compared to left hemispheric injury (p < 0.001). ST segment level at the J point decreased 24 and 48 h after TBI in leads I, II, III, aVR, aVF, V1, V2, V3 and V6, and increased in lead V1, especially in non-survivors.

CONCLUSIONS

Spatial QRS-T angle and QTc interval increase after TBI. If foraminal herniation complicates TBI, further widening of the spatial QRS-T angle typically precedes it, followed by notable narrowing thereafter. Increased IAP also intensifies TBI-associated increases in spatial QRS-T angle and QTc interval.

Intra-abdominal hypertension increases spatial QRS-T angle and elevates ST-segment J-point in healthy women undergoing laparoscopic surgery

BACKGROUND

Intra-abdominal hypertension (IAH) impairs cardiovascular function, however an effect of IAH on cardiac electrophysiology has been poorly documented. The aim of this study was to evaluate the effect of IAH following pneumoperitoneum on vectorcardiographic variables reflecting cardiac repolarisation and depolarisation.

METHODS

Otherwise healthy women undergoing elective gynaecological laparoscopy were studied. Intra-abdominal pressure (IAP), spatial QRS-T angle and ST-segment J-point (STJ) were observed during surgery and the early postoperative period.

RESULTS

Forty women, ages 22 to 43 were examined. Induction of IAH to 15mmHg significantly widened the spatial QRS-T angle, whereas the Trendelenburg position subsequently reduced this widening. IAH also increased STJ voltage in leads III, aVF, V2 and V3 during surgery, with increased STJ voltage persisting in several leads through the morning of postoperative day 1.

CONCLUSION

Induction of IAH impacts the relationship between cardiac depolarisation and repolarisation and increases spatial QRS-T angle and STJ voltage.

Effect of Dexmedetomidine on Heart Rate-Corrected QT and Tpeak-Tend Intervals During Robot-Assisted Laparoscopic Prostatectomy With Steep Trendelenburg Position: A Prospective, Randomized, Double-Blinded, Controlled Study

Intraperitoneal insufflation of carbon dioxide may affect the sympathetic activity that leads to changes in ventricular repolarization. This in turn can result in changes of heart rate-corrected QT (QTc) interval and Tpeak-Tend (Tp-e) interval. Dexmedetomidine is a highly selective α2-receptor agonist and has potential antiarrhythmic properties. This prospective, randomized, double-blinded, controlled study evaluated the effects of dexmedetomidine administration on QTc and Tp-e intervals during robot-assisted laparoscopic prostatectomy with steep Trendelenburg position.Fifty patients scheduled for robot-assisted laparoscopic prostatectomy randomly received either a continuous infusion of dexmedetomidine at a rate of 0.3 μg/kg/hour, from anesthetic induction until the end of the Trendelenburg position (dexmedetomidine group; n = 25), or the same volume of normal saline (control group; n = 25). Anesthesia was maintained with sevoflurane and remifentanil. The primary and secondary goals were to evaluate the effect of dexmedetomidine on the QTc and Tp-e interval changes. Mean arterial pressure, heart rate, end-tidal CO2, and end-tidal sevoflurane concentrations were assessed as well.Forty-seven patients (94%) completed the study. Dexmedetomidine significantly attenuated QTc interval prolongation and reduced the Tp-e interval, even though the baseline values of the QTc and Tp-e intervals were similar between the 2 groups (PGroup × Time = 0.001 and 0.014, respectively). Twenty-two patients (96%) in the control group and 13 (54%) in the dexmedetomidine group had QTc interval prolongation of >20 ms from the baseline value during surgery (P = 0.001). The maximum QTc interval prolongation from the baseline value during surgery was 46 ± 21 ms in the control group and 24 ± 21 ms in the dexmedetomidine group (mean ± SD, P = 0.001). Mean arterial pressure and heart rate were comparable between the groups.Continuous infusion of dexmedetomidine at a rate of 0.3 μg/kg/hour significantly attenuated the QTc interval prolongation induced by CO2 pneumoperitoneum with steep Trendelenburg position. Furthermore, dexmedetomidine reduced the Tp-e interval. Thus, dexmedetomidine administration may be effective for patients who are susceptible to the development of ventricular arrhythmia during robot-assisted laparoscopic prostatectomy.

Laparoscopic surgery: does it increase the probability of atrial and ventricular arrhythmias in children?

PURPOSE

Despite the minor physiologic changes those occur during laparoscopic procedures, pneumoperitoneum with CO2 insufflation may induce alterations in electrocardiographic (ECG) variables, which may predict severe atrial and ventricular arrhythmias. This study aims to assess QT dispersion (QTD) and P wave dispersion (PWD) changes in children who have undergone laparoscopic appendectomy.

PATIENTS AND METHODS

Sixteen patients (12 males and 4 females) who had preoperative diagnosis of appendicitis were included in the study. As laparoscopic exploration revealed appendicitis in all patients, laparoscopic appendectomy was performed. Preinsufflation (ECG1), postinsufflation (ECG2), predesufflation (ECG3), and postdesufflation (ECG4) ECGs were achieved at a speed of 25 mm/s for QTD and PWD analyses.

RESULTS

Although mean corrected QTD and PWD at ECG2 and ECG3 were significantly greater than ECG1 and ECG4, those changes induced by insufflation of CO2 were reversible.

CONCLUSIONS

The clinical significance of pneumoperitoneum, which causes an increase in corrected QTD and PWD in children, remains to be determined with further studies.

Comparison Between Intraperitoneal CO2 Insufflation and Abdominal Wall Lift on QT Dispersion and Rate-corrected QT Dispersion During Laparoscopic Cholecystectomy

This study compared the effect of intraperitoneal CO2 insufflation with abdominal wall lift on RR interval, QT interval, the rate-corrected QT (QTc) interval, QT dispersion (QTD), and the rate-corrected QTD (QTcD) using computerized measurement during laparoscopic cholecystectomy. Thirty patients scheduled for laparoscopic cholecystectomy were randomly assigned to 2 groups: intraperitoneal CO2 insufflation (CO2 group) or abdominal wall lift (lift group). A 12-lead electrocardiogram was monitored to measure parameters. The RR interval, QT interval, and QTc interval did not change significantly during the study in both groups. The QTD and QTcD in the CO2 group increased significantly during CO2 insufflation, and were significantly higher than those of the lift group. Statistically significant increases of QTD and QTcD, which are associated with an increased risk of arrhythmias and cardiac events, occur during CO2 insufflation, and QTD and QTcD in the CO2 group were significantly higher than those of the lift group.