Genç Ali, Özsoy Uğur, Şahin Ahmet Tuğrul, Gürler Balta Mehtap, Kölükçü Vildan, Genç Tapar Gülşen, Karaman Tuğba, Karaman Serkan
Anesthesiology and Reanimation Department, Tokat Gaziosmanpasa University Hospital, Tokat, Turkey.
General Surgery Department, Tokat Gaziosmanpasa University Hospital, Tokat, Turkey.
Medicine (Baltimore). 2025 Mar 14;104(11):e41934. doi: 10.1097/MD.0000000000041934.
Increased intra-abdominal pressure during laparoscopic surgery, anesthesia, patient position, and neuroendocrine response may increase the risk of arrhythmia. This study aimed to investigate the perioperative changes in the frontal QRS-T angle in patients undergoing laparoscopic cholecystectomy under general anesthesia. Therefore, electrophysiological parameters at different stages of laparoscopic cholecystectomy were studied using the frontal QRS-T angle and the risk of arrhythmia susceptibility was investigated. This prospective observational study included 48 patients aged 23 to 65 years with an American Society of Anesthesiologists score of 1 to 3 who underwent laparoscopic cholecystectomy in the operating room of Gaziosmanpaşa University Research and Application Hospital. Electrocardiographic recordings were obtained immediately before surgery, immediately before and after intra-abdominal carbon dioxide insufflation, 2 minutes after reverse Trendelenburg, immediately after extubation, and 2 hours postoperatively, and the frontal plane QRS-T angle, QT and QTc interval were studied. Rhythm disturbances, bleeding and complications were recorded. The frontal QRS-T angle, QT and QTc interval were significantly increased with intra-abdominal hypertension (IAH) compared to baseline (P < .001, P < .001, P < .001, respectively). Similarly, frontal QRS-T angle, QT, and QTc interval increased significantly with reverse Trendelenburg position compared to baseline (P < .001, P < .001, P < .001, respectively). The frontal QRS-T angle, which increased with IAH and the reverse Trendelenburg position, significantly decreased immediately after the patient woke up (P < .001). Heart rate and mean arterial pressure increased significantly with IAH compared to those just before carbon dioxide insufflation (P = .03, P < .001, respectively). The present study found that IAH induction and reverse Trendelenburg positioning increased the frontal QRS-T angle, QT, and QTc interval in patients undergoing laparoscopic cholecystectomy. These prolonged values may cause serious arrhythmias, particularly in patients with cardiac disease. Therefore, it is very important for anesthetists to be aware of electrocardiographic changes such as arrhythmias in patients undergoing laparoscopic cholecystectomy.
腹腔镜手术期间腹内压升高、麻醉、患者体位及神经内分泌反应可能增加心律失常风险。本研究旨在调查全身麻醉下接受腹腔镜胆囊切除术患者围手术期额面QRS-T角的变化。因此，利用额面QRS-T角研究了腹腔镜胆囊切除术不同阶段的电生理参数，并调查了心律失常易感性风险。这项前瞻性观察性研究纳入了48例年龄在23至65岁、美国麻醉医师协会评分为1至3分的患者，他们在加济奥斯曼帕夏大学研究与应用医院手术室接受腹腔镜胆囊切除术。在手术前即刻、腹内二氧化碳充气前后即刻、头低脚高位2分钟后、拔管后即刻及术后2小时获取心电图记录，并研究额面QRS-T角、QT及QTc间期。记录心律失常、出血及并发症情况。与基线相比，腹内高压（IAH）时额面QRS-T角、QT及QTc间期显著增加（分别为P < 0.001、P < 0.001、P < 0.001）。同样，与基线相比，头低脚高位时额面QRS-T角、QT及QTc间期显著增加（分别为P < 0.001、P < 0.001、P < 0.001）。随IAH及头低脚高位增加的额面QRS-T角在患者苏醒后即刻显著降低（P < 0.001）。与二氧化碳充气前相比，IAH时心率及平均动脉压显著升高（分别为P = 0.03、P < 0.001）。本研究发现，IAH诱导及头低脚高位会增加腹腔镜胆囊切除术患者的额面QRS-T角、QT及QTc间期。这些延长的值可能导致严重心律失常，尤其是在患有心脏病的患者中。因此，麻醉医生了解腹腔镜胆囊切除术患者的心律失常等心电图变化非常重要。
