Thoracoscopic T2 Sympathicotomy Effects on QT Interval / 대한마취과학회지

BACKGROUND: Thoracoscopic sympathicotomy was, at first, thought to be a simple and safe method for treatment of hyperhydrosis. However, few studies refer to the cardiac effects of this procedure, despite the fact that the T2 ganglia are in the direct pathway of the sympathetic innervation of the heart. An imbalance of right and left sympathetic efferent activity has been proposed as a mechanism for arrhythmia in patients with long QT syndrome. The aim of this study was to compare hemodynamic effect as well as ECG changes after right and left side sympathicotomy. METHODS: 42 patients with essential hyperhydrosis in ASA physical status class 1 undergoing thoracoscopic sympathicotomy were randomly divided into two groups: left side first operation group (group L, n = 22) and right side first operation group (group R, n = 20). Anesthesia was induced with thiopental sodium (5 mg/kg) and pancuronium (0.05 mg/Kg) and maintained with enflurane. During the procedure, we recorded blood pressure at both forearms and heart rate and ECG were recorded after anesthetic induction as baseline values, immediately after one side resectioned of sympathetic trunk, and after complete resectioning of both side. All operations were done with usual methods by experienced surgeons. All the records were coded and analysed singl blind by one author. RESULTS: After sympathicotomy, there was a significant decrease in heart rate but not in blood pressure. However, statistically there were no significant changes in QT interval during sympathicotomy either right side first operation or left side first operation. CONCLUSIONS: The main result of this study was that there were no significant changes in QT interval during sympathicotomy of either right or left side first operations. However, This does not mean that there was no possibility of prolongation of QT interval during thoracoscopic sympathicotomy. Careful observation of QT interval changes is needed during sympathicotomy.

Electrocardiographic Abnormalities after Subarachnoid Hemorrhage / 대한마취과학회지

BACKGROUND: Electrocardiogram was one of the routine monitorings not only using for preanesthetic assessment but also in the operation room and ICU. Electrocardiographic changes are reported frequently after subarachnoid hemorrhage. Preanesthetic assessment of ECG abnormalities in the patients with subarachnoid hemorrhage is important. The aim of this study was to investigate the functional significance of ECG changes for perioperative assessment of cardiac function. METHODS: For premedication, patients were administered glycopyrrolate 0.2 mg 1 hour prior to induction. Induction was established with pentothal sodium, succinylcholine after precurarization and preoxygenation. N2O/O2 (2:1), isoflurane and pancuronium were administered for maintenance. The monitorings for patients were performed ECG (5 leads), direct atrial pressure, ETCO2, CVP and rectal temperature. RESULTS: ECG abnormalities consisted of T wave abnormalities, ST segment changes, abnormal Q wave, QT interval prolongation, LVH and arrhythmia etc. We analyzed 41 of 108 SAH patients who had ECG abnormalities of neurogenic origin preoperatively. Of these, 46% in T wave, 17% in LVH, 15% in Q wave, 15% in ST segment changes and 7% in the others (CRBBB, PAC, AF) were found. CONCLUSIONS: It is concluded that we found a poor relationship between electrocardiographic changes after subarachnoid hemorrhage and evidences of myocardial dysfunction on the echocardiogram. General anesthesia in the patients of the subarachnoid hemorrhage must not be delayed in the patients with ECG abnormalities of neurogenic origin. A preanesthetic cardiac assessment in the patients with ECG abnormalities of cardiogenic origin must be always performed.