Pneumoperitoneum induces significant pathophysiological changes. Changes in performance of cardiovascular system can be severe in patients with compromised cardiac function. Groups of patients to whom these changes may be deleterious are yet to be identified. Aim of the study was to elucidate the influence of pneumoperitoneum on the electrocardiographic recording.
Patients and methods: 35 cardiovascular healthy (ASA I-II) patients (group 1) and 34 patients with underlying moderate ischemic heart disease (ASA II-IV, Goldman's cardiac risk class II-III) (group 2), scheduled for elective laparoscopic cholecystectomy, were included in the study. Premedication included sedatives for all patients and the group 2 received their usual cardiovascular treatment one hour before operation. A standardized protocol of monitoring and anesthesia was followed in the operating room. 12 lead electrocardiograms (ECG) were obtained before and after induction of anesthesia, every 10 minutes during pneumoperitoneum, after the peritoneal desufflation and after extubation. The ECGs were recorded and analysed by the means of computerized system for ECG record and analysis "Kaunas" (UAB "Kardiosignalas", Kaunas, Lithuania). The analysis was performed postoperatively.
Results: During pneumoperitoneum a deviation of cardiac electrical axis to the left was observed. There were no marked changes in duration of P wave, P-Q interval, and QRS complex. Following abdominal insufflation a tendency to flattening of T wave was observed returning to the initial position after desufflation. No significant dislocation of ST segment was recorded.
Conclusions: The pneumoperitoneum induced changes of cardiac electrical axis can affect the interpretation of ECG seen on a cardiac monitor during anesthesia. Pneumoperitoneum does not pose patients with moderate ischemic heart disease at additional risk of developing myocardial ischemia.