Department of Anesthesia, Miyazaki Dental Welfare Center, Miyazaki City Dental Association, Miyazaki, Miyazaki, Japan.
Section of Dental Anesthesiology, Division of Maxillofacial Diagnostic & Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka, Fukuoka, Japan.
Sci Rep. 2022 Aug 2;12(1):13279. doi: 10.1038/s41598-022-17680-4.
Anesthesiologists often compare intraoperative and preoperative electrocardiogram (ECG) waveforms in patients undergoing general anesthesia. In addition, many intraoperative ECG monitors have filters for removing electrocautery noise. In pediatric anesthesiology practice, we often note the appearance of elevated T waves-specifically, an increase in their height-with the use of such filters, even though no actual clinical change has occurred, which possibly leads to misdiagnosis. We investigated changes in R and T wave heights and in the T/R ratio according to the use of the strong (S) versus the diagnostic (D) filtering mode during pediatric anesthesiology. Primary outcomes were the dependence of the heights of the R and T waves on the filter mode and the correlation between rates of change in the R- and T-wave heights and heart rate (HR). In the S mode, the height of the R wave was lower (p = 0.013, η = 0.28) and the T/R ratio was higher than the corresponding values in the D mode (χ = 20.46, p < 0.001). The T/R ratios were also higher in the S mode than in the D mode, and when the D mode was changed to the S mode during tachycardia, there was a strong correlation between the rate of reduction in the R wave and HR (r = 0. 573, p = 0.041). Significant differences in the heights of the R wave and in the T/R ratio occur when using different intraoperative ECG filtering modes. Specifically, in S mode, a greater relative increase in T wave height may occur due to a significant decrease in R wave height. To avoid spurious diagnoses, anesthesiologists should be familiar with these potentially purely filter-driven changes whenever ECG is intraoperatively monitored.
麻醉师在为接受全身麻醉的患者进行手术期间通常会比较术中与术前心电图（ECG）波形。此外，许多术中 ECG 监测器都具有用于消除电灼噪声的滤波器。在儿科麻醉学实践中，我们经常注意到使用这些滤波器会出现 T 波抬高——具体来说，T 波高度增加——尽管实际上并未发生任何临床变化，这可能导致误诊。我们研究了在儿科麻醉学中使用强（S）滤波模式与诊断（D）滤波模式时 R 和 T 波高度以及 T/R 比值的变化。主要结局是 R 和 T 波高度取决于滤波器模式，以及 R 和 T 波高度变化率与心率（HR）之间的相关性。在 S 模式中，R 波高度较低（p=0.013，η=0.28），T/R 比值高于 D 模式（χ=20.46，p<0.001）。S 模式中的 T/R 比值也高于 D 模式，并且当心动过速时将 D 模式切换为 S 模式时，R 波降低率与 HR 之间存在很强的相关性（r=0.573，p=0.041）。使用不同的术中 ECG 滤波模式时，R 波和 T/R 比值的高度会出现显著差异。具体而言，在 S 模式中，由于 R 波高度的显著降低，T 波高度可能会出现更大的相对增加。为避免误诊，麻醉师在术中监测 ECG 时应熟悉这些可能纯粹由滤波器引起的变化。
