Owczuk Radoslaw, Wujtewicz Magdalena A, Sawicka Wioletta, Polak-Krzeminska Agnieszka, Suszynska-Mosiewicz Aleksandra, Raczynska Krystyna, Wujtewicz Maria
Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Poland.
Clin Exp Pharmacol Physiol. 2008 Sep;35(9):1071-6. doi: 10.1111/j.1440-1681.2008.04963.x. Epub 2008 May 25.
Anaesthetics influence cardiac electrical activity by various mechanisms; thus, they may have pro-arrhythmic or anti-arrhythmic actions. Increased P-wave dispersion is associated with a risk of paroxysmal atrial fibrillation. The aim of the present study was to analyse the impact of propofol and desflurane on changes in P wave dispersion, which may reflect the anti-arrhythmic effects of these drugs. Fifty patients undergoing scheduled surgery were included in the study. Patients were divided into two equal groups: a propofol group and a desflurane group. Patients in the propofol group were initially administered 2.5 mg/kg propofol, followed by infusion of 6 mg/kg per h propofol. Anaesthesia in the desflurane group was achieved using inhalation induction, with concentrations up to 8-12.5 vol%. When signs of adequate anaesthesia were observed, the concentration of desflurane was reduced to 6 vol%. An electrocardiogram (ECG) was obtained before induction and then again 1, 3 and 5 min after the initiation of propofol infusion or the induction of anaesthesia in the desflurane group; additional measurements were performed after tracheal intubation. P-wave dispersion was assessed by differences in maximal and minimal P-wave duration on a 12-lead ECG. P-wave dispersion did not change over time in the desflurane group. In the propofol group, there was a significant decrease in P-wave dispersion after 3 and 5 min of anaesthesia. Significant differences were observed between study groups after 1, 3 and 5 min of anaesthesia, and disappeared after tracheal intubation. Mean and maximal P-wave duration did not change in either group. In conclusion, propofol decreases P-wave dispersion and this seems to be connected with the anti-arrhythmic properties of the drug.
麻醉药通过多种机制影响心脏电活动；因此，它们可能具有促心律失常或抗心律失常作用。P波离散度增加与阵发性心房颤动风险相关。本研究的目的是分析丙泊酚和地氟醚对P波离散度变化的影响，这可能反映这些药物的抗心律失常作用。50例接受择期手术的患者纳入本研究。患者被分为两组，每组人数相等：丙泊酚组和地氟醚组。丙泊酚组患者最初静脉注射2.5mg/kg丙泊酚，随后以6mg/kg每小时的速度输注丙泊酚。地氟醚组采用吸入诱导麻醉，浓度高达8 - 12.5 vol%。当观察到充分麻醉的体征时，将地氟醚浓度降至6 vol%。在诱导前、丙泊酚输注开始后或地氟醚组麻醉诱导后1、3和5分钟分别记录心电图（ECG）；气管插管后进行额外测量。通过12导联心电图上最大和最小P波时限的差值评估P波离散度。地氟醚组P波离散度随时间未发生变化。丙泊酚组麻醉3和5分钟后P波离散度显著降低。麻醉1、3和5分钟后研究组间观察到显著差异，气管插管后差异消失。两组的平均和最大P波时限均未改变。总之，丙泊酚可降低P波离散度，这似乎与该药物的抗心律失常特性有关。
