Comparison of the regional and general anesthesia as a risk factor of perioperative arrhythmia: a two-group observational study
Background. Regional anesthesia has become widely used in routine anesthesiology practice, it is considered a safer method of anesthesia in older patients and those with concomitant pathology. Nevertheless, both general and regional anesthesia have side effects on the cardiovascular system. The card...
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Zaslavsky O.Yu.
2024-11-01
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| Series: | Медицина неотложных состояний |
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| Online Access: | https://emergency.zaslavsky.com.ua/index.php/journal/article/view/1783 |
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| author | N.M. Semenko Iu.L. Kuchyn K.Yu. Bielka M.S. Frank |
| author_facet | N.M. Semenko Iu.L. Kuchyn K.Yu. Bielka M.S. Frank |
| author_sort | N.M. Semenko |
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| description | Background. Regional anesthesia has become widely used in routine anesthesiology practice, it is considered a safer method of anesthesia in older patients and those with concomitant pathology. Nevertheless, both general and regional anesthesia have side effects on the cardiovascular system. The cardiotoxic effect of anesthesia in one way or another is present with any variant of anesthesia. One of the most transparent signs is rhythm alterations on the ECG. These changes can occur not only intraoperatively, but also in the early postoperative period, have an asymptomatic clinical course. But the presence of these signs can have a negative impact on the patient’s prognosis. That is why we performed daily Holter monitoring for patients undergoing trauma surgery. The purpose of the study was to compare regional and general anesthesia as a risk factor for perioperative rhythm disturbances. Materials and methods. It was a 2-group observational study that included 120 trauma patients undergoing surgery using general (group GA) or regional anesthesia (group RA). Postoperative Holter monitoring lasted 24 hours. Further analysis of the recording included the assessment of the presence of ischemic changes or extrasystoles. Results. The incidence of ST-depression episodes within 24 perioperative hours was 10 % in the GA group compared to 3 % in the RA group. In the GA group, the percentage of extrasystole was significantly higher compared to the RA group: 1.5 ± 2.1 % versus 0.7 ± 1.3 % (p = 0.0145). An increase in Qtd was significantly higher in the GA group 15 minutes after the start of anesthesia (51.31 ± 23.09) compared to the RA group (40.70 ± 19.97; p = 0.008). At the same time, QT dispersion was statistically significantly higher in the RA group 1 hour after the start of anesthesia compared to the GA group — 38.22 ± 12.30 versus 50.1 ± 19.5 (p = 0.04). The QT interval was significantly longer in the GA group 15 minutes after the start of anesthesia: 440.00 ± 33.09 versus 400.70 ± 23.18 in the RA group (p = 0.04). One hour after the start of anesthesia, QTt was longer in the RA group: 390.22 ± 23.60 versus 410.1 ± 30.1 in the GA group (p = 0.05). Conclusions. Regional anesthesia has less hemodynamic effects and is the method of choice in patients with cardiovascular comorbidity. However, given the risk of cardiotoxicity due to the resorptive effect of the local anesthetic, in older patients and with existing risk factors, it is crucial to account for the arrhythmogenic effects of local anesthetics and adjust the dosage accordingly. |
| format | Article |
| id | doaj-art-45a6d2953e9c4430adeb88f7845a79d0 |
| institution | Kabale University |
| issn | 2224-0586 2307-1230 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Zaslavsky O.Yu. |
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| spelling | doaj-art-45a6d2953e9c4430adeb88f7845a79d02025-01-12T11:41:05ZengZaslavsky O.Yu.Медицина неотложных состояний2224-05862307-12302024-11-0120763263710.22141/2224-0586.20.7.2024.17831783Comparison of the regional and general anesthesia as a risk factor of perioperative arrhythmia: a two-group observational studyN.M. Semenko0https://orcid.org/0000-0001-8235-386XIu.L. Kuchyn1https://orcid.org/0000-0002-9667-1911K.Yu. Bielka2https://orcid.org/0000-0003-1185-6835M.S. Frank3https://orcid.org/0009-0007-6693-1202Bogomolets National Medical University, Kyiv, UkraineBogomolets National Medical University, Kyiv, UkraineBogomolets National Medical University, Kyiv, UkraineBogomolets National Medical University, Kyiv, UkraineBackground. Regional anesthesia has become widely used in routine anesthesiology practice, it is considered a safer method of anesthesia in older patients and those with concomitant pathology. Nevertheless, both general and regional anesthesia have side effects on the cardiovascular system. The cardiotoxic effect of anesthesia in one way or another is present with any variant of anesthesia. One of the most transparent signs is rhythm alterations on the ECG. These changes can occur not only intraoperatively, but also in the early postoperative period, have an asymptomatic clinical course. But the presence of these signs can have a negative impact on the patient’s prognosis. That is why we performed daily Holter monitoring for patients undergoing trauma surgery. The purpose of the study was to compare regional and general anesthesia as a risk factor for perioperative rhythm disturbances. Materials and methods. It was a 2-group observational study that included 120 trauma patients undergoing surgery using general (group GA) or regional anesthesia (group RA). Postoperative Holter monitoring lasted 24 hours. Further analysis of the recording included the assessment of the presence of ischemic changes or extrasystoles. Results. The incidence of ST-depression episodes within 24 perioperative hours was 10 % in the GA group compared to 3 % in the RA group. In the GA group, the percentage of extrasystole was significantly higher compared to the RA group: 1.5 ± 2.1 % versus 0.7 ± 1.3 % (p = 0.0145). An increase in Qtd was significantly higher in the GA group 15 minutes after the start of anesthesia (51.31 ± 23.09) compared to the RA group (40.70 ± 19.97; p = 0.008). At the same time, QT dispersion was statistically significantly higher in the RA group 1 hour after the start of anesthesia compared to the GA group — 38.22 ± 12.30 versus 50.1 ± 19.5 (p = 0.04). The QT interval was significantly longer in the GA group 15 minutes after the start of anesthesia: 440.00 ± 33.09 versus 400.70 ± 23.18 in the RA group (p = 0.04). One hour after the start of anesthesia, QTt was longer in the RA group: 390.22 ± 23.60 versus 410.1 ± 30.1 in the GA group (p = 0.05). Conclusions. Regional anesthesia has less hemodynamic effects and is the method of choice in patients with cardiovascular comorbidity. However, given the risk of cardiotoxicity due to the resorptive effect of the local anesthetic, in older patients and with existing risk factors, it is crucial to account for the arrhythmogenic effects of local anesthetics and adjust the dosage accordingly.https://emergency.zaslavsky.com.ua/index.php/journal/article/view/1783regional anesthesia cardiac toxicityrhythm alterationsgeneral anesthesia |
| spellingShingle | N.M. Semenko Iu.L. Kuchyn K.Yu. Bielka M.S. Frank Comparison of the regional and general anesthesia as a risk factor of perioperative arrhythmia: a two-group observational study Медицина неотложных состояний regional anesthesia cardiac toxicity rhythm alterations general anesthesia |
| title | Comparison of the regional and general anesthesia as a risk factor of perioperative arrhythmia: a two-group observational study |
| title_full | Comparison of the regional and general anesthesia as a risk factor of perioperative arrhythmia: a two-group observational study |
| title_fullStr | Comparison of the regional and general anesthesia as a risk factor of perioperative arrhythmia: a two-group observational study |
| title_full_unstemmed | Comparison of the regional and general anesthesia as a risk factor of perioperative arrhythmia: a two-group observational study |
| title_short | Comparison of the regional and general anesthesia as a risk factor of perioperative arrhythmia: a two-group observational study |
| title_sort | comparison of the regional and general anesthesia as a risk factor of perioperative arrhythmia a two group observational study |
| topic | regional anesthesia cardiac toxicity rhythm alterations general anesthesia |
| url | https://emergency.zaslavsky.com.ua/index.php/journal/article/view/1783 |
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