Pehlivan Basak, Akçay Murat, Atlas Ahmet, Erol Mehmet K, Duran Erdogan, Karahan Mahmut A, Binici Orhan, Büyükfırat Evren, Altay Nuray
Anesthesiology, Harran University, Sanliurfa, TUR.
Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Anesthesiology and Reanimation Clinic, Ankara, TUR.
Cureus. 2020 Jul 8;12(7):e9079. doi: 10.7759/cureus.9079.
Introduction Arrhythmias are one of the most frequently seen issues during surgical operations. In this study, we investigated and compared the effects on the QT dispersion of patients when using a method of volatile inhalation mask anesthesia with sevoflurane (VIMA: Group I) and when spinal anesthesia was performed with levobupivacaine (Group II). Methods The study included 40 patients who had American Society of Anesthesiology scores of I-II (ASA I-II), were aged from 18 to 65 years, and were scheduled for inguinal hernia operations. Approval of the university ethics committee was obtained before the study began. All patients had measurements taken for non-invasive blood pressure, including systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SO) values. The QT intervals were measured using the 12-derivation electrocardiogram (ECG) device (Cardiofax V). Our study was performed with randomization using the closed envelope method. Results When the percentage differences of the HR values from the initial period in both groups were compared, we observed significant differences between the groups, with increases in the VIMA group at the second period as well as increases in the VIMA group at the fourth, fifth, sixth, seventh, and ninth periods but decreases in the spinal anesthesia group for these periods. There were statistically significant differences between the two groups at the third and fifth periods when the percentage differences of the QTc values from the initial period were compared. We observed increases in the spinal anesthesia group. Conclusion In our study, we suggest that the tendency toward arrhythmia may be reduced by choosing general anesthesia with sevoflurane rather than levobupivacaine in patients with cardiac complaints who are undergoing regional anesthesia and/or taking medication that affects QT intervals.
引言
心律失常是外科手术中最常见的问题之一。在本研究中，我们调查并比较了使用七氟醚挥发性吸入面罩麻醉方法（VIMA：第一组）和左旋布比卡因脊髓麻醉（第二组）时对患者QT离散度的影响。
方法
该研究纳入了40例美国麻醉医师协会评分I-II级（ASA I-II）、年龄在18至65岁之间且计划进行腹股沟疝手术的患者。研究开始前获得了大学伦理委员会的批准。所有患者均测量了无创血压，包括收缩压（SAP）、舒张压（DAP）和平均动脉压（MAP）、心率（HR）以及血氧饱和度（SO）值。使用12导联心电图（ECG）设备（Cardiofax V）测量QT间期。我们的研究采用封闭信封法进行随机分组。
结果
比较两组HR值与初始期相比的百分比差异时，我们观察到两组之间存在显著差异，VIMA组在第二期以及第四、五、六、七和九期HR值升高，而脊髓麻醉组在这些时期HR值下降。比较两组QTc值与初始期相比的百分比差异时，在第三和五期两组之间存在统计学显著差异。我们观察到脊髓麻醉组QTc值升高。
结论
在我们的研究中，我们建议对于有心脏问题且正在接受区域麻醉和/或服用影响QT间期药物的患者，选择七氟醚全身麻醉而非左旋布比卡因，可能会降低心律失常的倾向。
