Abstract
Purpose
To compare the influence of a longer duration of intraperitoneal CO2 insufflation with head-up tilt on electrocardiogram indices during laparoscopic cholecystectomy between elderly and younger patients.
Methods
Twelve elderly and 12 younger patients were studied. In all patients, intraperitoneal CO2 insufflation was performed for more than 150 min in the head-up position. RR interval, QT interval, the rate-corrected QT (QTc) interval, QT dispersion (QTD) and the rate-corrected QTD (QTcD) were measured.
Results
The QT interval and the QTc interval increased significantly from 120 to 150 min after CO2 insufflation in the elderly. The QTD and QTcD increased significantly during CO2 insufflation in both groups. Those were significantly greater in the elderly than in younger patients from 120 to 150 min after CO2 insufflation.
Conclusion
Longer duration of CO2 insufflation with head-up tilt is associated with a prolongation of the QT interval and the QTD in elderly patients. The clinical significance of these findings remains to be determined.
Résumé
Objectif
Comparer l’influence d’une insufflation intrapéritonéale prolongée de CO2 en position de Fowler, sur les indices de l’électrocardiogramme pendant la cholécystectomie laparoscopique, entre les patients âgés et de jeunes patients.
Méthode
Douze patients âgés et douze jeunes patients ont participé à l’étude, L’insufflation de CO2 a été réalisée pendant plus de 150 min en position de Fowler chez tous les patients. L’intervalle RR, l’intervalle QT, l’intervalle QT corrigé pour la fréquence (QTc), la dispersion QT (QTd) et la QTd corrigée pour la fréquence (QTcD) ontété mesurés.
Résultats
L’intervalle QT et l’intervalle QTc ont augmenté significativement de 120 à 150 min après l’insufflation de CO2 chez les patients âgés. Le QTD et le QTcD ont augmenté de façon significative pendant l’insufflation de CO2 chez tous les patients. Ces résultats ont été plus élevés chez les patients âgés comparés aux jeunes patients, entre 120 et 150 min après l’insufflation de CO2.
Conclusion
Une insufflation prolongée de CO2 en position de Fowler est associée à des intervalles QT et QTD également prolongés chez les patients âgés. La portée clinique de ces résultats demeure indéterminée.
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References
Hirvonen EA, Poikolainen EO, Paakkonen ME, Nuutinen LS. The adverse hemodynamic effects of anesthesia, head-up tilt, and carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy. Surg Endosc 2000; 14: 272–7.
Dorsay DA, Greene FL, Baysinger CL. Hemodynamic changes during laparoscopic cholecystectomy monitiored with transesophageal echocardiography. Surg Endosc 1995; 9: 128–34.
Day CP, McComb JM, Campbell RWF. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J 1990; 63: 342–4.
de Bruyne MC, Hoes AW, Kors JA, Hofman A, van Bemmel JH, Grobbee DE. QTc dispersion predicts cardiac mortality in the elderly. The Rotterdam study. Circulation 1998; 97: 467–72.
Dabrowski A, Kramarz E, Piotrowicz R. Dispersion of QT interval following ventricular premature beats and mortality after myocardial infarction. Cardiology 1999; 91: 75–80.
Okin PM, Devereux RB, Howard BV, Fabsitz RR, Lee ET, Welty TK. Assessment of QT interval and QT dispersion for prediction of all-cause and cardiovascular mortality in American Indians. The strong heart study. Circulation 2000; 101: 61–6.
McLaughlin NB, Campbell RWF, Murray A. Accuracy of four automatic QT measurement techniques in cardiac patients and healthy subjects. Heart 1996; 76: 422–6.
Xue Q, Reddy S. Algorithms for computerized QT analysis. J Electrocardiol 1998; 30(suppl): 181–6.
Fisch C. Electrocardiography.In: Braunwald E (Ed.). Heart Disease: A textbook of Cardiovascular Medicine, 5th ed. Philadelphia: W.B. Saunders Company, 1997: 114.
Tran H, White CM, Chow MSS, Kluger J. An evaluation of the impact of gender and age on QT dispersion in healthy subjects. Ann Noninvasive Electrocardiol 2001; 6: 129–33.
Lakatta EG. Alterations in the cardiovascular system that occur in advanced age. Fed Proc 1979; 38: 163–7.
Giannattasio C, Ferrari AU, Mancia G. Alterations in neural cardiovascular control mechanisms with aging. J Hypertens 1994; 12(suppl): S13–7.
Nakagawa M, Takahashi N, Iwao T, et al. Evaluation of autonomic influences on QT dispersion using the head-up tilt test in healthy subjects. PACE 1999; 22: 1158–63.
Kiely DG, Cargill RI, Lipworth BJ. Effects of hypercapnia on hemodynamic, inotropic, lusitropic, and electrophysiologic indices in humans. Chest 1996; 109: 1215–21.
Guler N, Bilge M, Eryonucu B, Kati I, Demirel CB. The effects of halothane and sevoflurane on QT dispersion. Acta Cardiol 1999; 54: 311–5.
Watanabe T, Kobayashi F, Furui H, et al. Assessment of sympathetic nerve activity controlling blood pressure in the elderly using head-up tilt. Environ Res 1993; 62: 251–5.
Zaidi M, Robert A, Fesler R, Derwael C, Brohet C. Dispersion of ventricular repolarisation: a marker of ventricular arrhythmias in patients with previous myocardial infarction. Heart 1997; 78: 371–5.
Randell T, Tanskanen P, Scheinin M, Kytta J, Ohman J, Lindgren L. QT dispersion after subarachnoid hemorrhage. J Neurosurg Anesthesiol 1999; 11: 163–6.
Aytemir K, Aksoyek S, Ozer N, Gurlek A, Oto A. QT dispersion and autonomic nervous system function in patients with type 1 diabetes. Int J Cardiol 1998; 65: 45–50.
Shimabukuro M, Chibana T, Yoshida H, Nagamine F, Komiya I, Takasu N. Increased QT dispersion and cardiac adrenergic dysinnervation in diabetic patients with autonomic neuropathy. Am J Cardiol 1996; 78: 1057–9.
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Egawa, H., Minami, J., Fujii, K. et al. QT interval and QT dispersion increase in the elderly during laparoscopic cholecystectomy: A preliminary study. Can J Anesth 49, 805–809 (2002). https://doi.org/10.1007/BF03017412
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DOI: https://doi.org/10.1007/BF03017412