Effects of long periods of pneumoperitoneum combined with the head-up position on heart rate-corrected QT interval during robotic gastrectomy: an observational study

Na Young Kim, Sun-Joon Bai, Hyoung-Il Kim, Jung Hwa Hong, Hoon Jae Nam, Jae Chul Koh, Hyun Joo Kim, Na Young Kim, Sun-Joon Bai, Hyoung-Il Kim, Jung Hwa Hong, Hoon Jae Nam, Jae Chul Koh, Hyun Joo Kim

Abstract

Objective: Pneumoperitoneum and the head-up position reportedly stimulate the sympathetic nervous system, potentially increasing the risk of cardiac arrhythmia. We evaluated the effects of a long duration of pneumoperitoneum in the head-up position on the heart rate-corrected QT (QTc) interval during robotic gastrectomy.

Methods: This prospective observational study involved 28 patients undergoing robotic gastrectomy. The QTc interval was recorded at the following time points: before anaesthetic induction (baseline); 10 minutes after tracheal intubation; 1, 5, 30, 60, and 90 minutes after pneumoperitoneum induction in the head-up position; after pneumoperitoneum desufflation in the supine position; and at the end of surgery. The primary outcome was the QTc interval, which was measured 90 minutes after pneumoperitoneum combined with the head-up position.

Results: Compared with baseline, the QTc interval was significantly prolonged at 1 and 60 minutes after pneumoperitoneum, peaked at 90 minutes, and was sustained and notably prolonged until the end of surgery. However, no considerable haemodynamic changes developed.

Conclusion: A long period of carbon dioxide pneumoperitoneum application in a head-up position significantly prolonged the QTc interval during robotic gastrectomy. Therefore, diligent care and close monitoring are required for patients who are susceptible to developing ventricular arrhythmia. Trial Registration: Registered at ClinicalTrials.gov; https://ichgcp.net/clinical-trials-registry/NCT02604979 ; Registration number NCT02604979.

Keywords: Carbon dioxide pneumoperitoneum; QTc interval; anaesthesia; cardiac arrhythmia; head-up position; robotic gastrectomy.

Figures

Figure 1.
Figure 1.
QTc interval from baseline until the end of surgery during robotic gastrectomy. QTc = heart rate-corrected QT interval; Baseline = before anaesthesia induction; Intu = 10 minutes after tracheal intubation; 1, 5, 30, 60, and 90 minutes = 1, 5, 30, 60, and 90 minutes after the start of pneumoperitoneum induction in the head-up position; Pneumoend = desufflation of pneumoperitoneum in the supine position; Surgeryend = end of surgery. Data are expressed as mean ± standard deviation. *p < 0.05 versus baseline value (Bonferroni-corrected).
Figure 2.
Figure 2.
Intraoperative haemodynamics Baseline = before anaesthesia induction; Intu = 10 minutes after tracheal intubation; 1, 5, 30, 60, and 90 minutes = 1, 5, 30, 60, and 90 minutes after the start of pneumoperitoneum induction in the head-up position; Pneumoend = desufflation of pneumoperitoneum in the supine position; Surgeryend = end of surgery. Data are expressed as mean ± standard deviation. *p < 0.05 versus baseline value (Bonferroni-corrected).

References

    1. Alimoglu O, Atak I, Eren T. Robot-assisted laparoscopic (RAL) surgery for gastric cancer. Int J Med Robot 2014; 10: 257–262.
    1. Lim SH, Lee HM, Son T, et al. Robotic surgery for gastric tumor: current status and new approaches. Transl Gastroenterol Hepatol 2016; 1: 28.
    1. Caruso S, Franceschini F, Patriti A, et al. Robot-assisted laparoscopic gastrectomy for gastric cancer. World J Gastrointest Endosc 2017; 9: 1–11.
    1. Acquafresca PA, Palermo M, Rogula T, et al. Most common robotic bariatric procedures: review and technical aspects. Ann Surg Innov Res 2015; 9: 9.
    1. Vilallonga R, Fort JM, Caubet E, et al. Robotic sleeve gastrectomy versus laparoscopic sleeve gastrectomy: a comparative study with 200 patients. Obes Surg 2013; 23: 1501–1507.
    1. Sato N, Kawamoto M, Yuge O, et al. Effects of pneumoperitoneum on cardiac autonomic nervous activity evaluated by heart rate variability analysis during sevoflurane, isoflurane, or propofol anesthesia. Surg Endosc 2000; 14: 362–366.
    1. Di Iorio C, Cafiero T, Di Minno RM. The effects of pneumoperitoneum and head-up position on heart rate variability and QT interval dispersion during laparoscopic cholecystectomy. Minerva Anestesiol 2010; 76: 882–889.
    1. Straus SM, Kors JA, De Bruin ML, et al. Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. J Am Coll Cardiol 2006; 47: 362–367.
    1. Scott DB, Julian DG. Observations on cardiac arrhythmias during laparoscopy. Br Med J 1972; 1: 411–413.
    1. Uemura N, Nomura M, Inoue S, et al. Changes in hemodynamics and autonomic nervous activity in patients undergoing laparoscopic cholecystectomy: differences between the pneumoperitoneum and abdominal wall-lifting method. Endoscopy 2002; 34: 643–650.
    1. Egawa H, Morita M, Yamaguchi S, et al. Comparison between intraperitoneal CO2 insufflation and abdominal wall lift on QT dispersion and rate-corrected QT dispersion during laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 2006; 16: 78–81.
    1. Egawa H, Minami J, Fujii K, et al. QT interval and QT dispersion increase in the elderly during laparoscopic cholecystectomy: a preliminary study. Can J Anaesth 2002; 49: 805–809.
    1. Findler M, Birger A, Diamant S, et al. Effects of head-up tilt-table test on the QT interval. Ann Noninvasive Electrocardiol 2010; 15: 245–249.
    1. Kim Y, Kim SY, Lee JS, et al. Effect of dexmedetomidine on the corrected QT and Tp-e intervals during spinal anesthesia. Yonsei Med J 2014; 55: 517–522.
    1. Nagele P, Pal S, Brown F, et al. Postoperative QT interval prolongation in patients undergoing noncardiac surgery under general anesthesia. Anesthesiology 2012; 117: 321–328.
    1. Ekici Y, Bozbas H, Karakayali F, et al. Effect of different intra-abdominal pressure levels on QT dispersion in patients undergoing laparoscopic cholecystectomy. Surg Endosc 2009; 23: 2543–2549.
    1. Staikou C, Stamelos M, Stavroulakis E. Impact of anaesthetic drugs and adjuvants on ECG markers of torsadogenicity. Br J Anaesth 2014; 112: 217–230.
    1. Mohamad MF, Mohammad MA, Hetta DF, et al. Thoracic epidural analgesia reduces myocardial injury in ischemic patients undergoing major abdominal cancer surgery. J Pain Res 2017; 10: 887–895.
    1. Vretzakis G, Simeoforidou M, Stamoulis K, et al. Supraventricular arrhythmias after thoracotomy: is there a role for autonomic imbalance? Anesthesiol Res Pract 2013; 2013: 413985.
    1. Silay E, Kati I, Tekin M, et al. Comparison of the effects of desflurane and sevoflurane on the QTc interval and QT dispersion. Acta Cardiol 2005; 60: 459–464.
    1. Min JJ, Lee J, Lee HC, et al. A comparison of the effects of sevoflurane and desflurane on corrected QT interval prolongation in patients undergoing living donor liver transplantation: a prospective observational study. Transplant Proc 2016; 48: 96–101.
    1. Yildirim H, Adanir T, Atay A, et al. The effects of sevoflurane, isoflurane and desflurane on QT interval of the ECG. Eur J Anaesthesiol 2004; 21: 566–570.
    1. Kim SH, Park SY, Chae WS, et al. Effect of desflurane at less than 1 MAC on QT interval prolongation induced by tracheal intubation. Br J Anaesth 2010; 104: 150–157.
    1. Xia Y, Liang Y, Kongstad O, et al. Tpeak-Tend interval as an index of global dispersion of ventricular repolarization: evaluations using monophasic action potential mapping of the epi- and endocardium in swine. J Interv Card Electrophysiol 2005; 14: 79–87.
    1. Tse G, Yan BP. Traditional and novel electrocardiographic conduction and repolarization markers of sudden cardiac death. Europace 2017; 19: 712–721.
    1. Elliott A, Johan Mork T, Hojlund M, et al. QTc interval in patients with schizophrenia receiving antipsychotic treatment as monotherapy or polypharmacy. CNS Spectr 2017; 1–6. doi:10.1017/S1092852917000402.
    1. Gibbons JA, Mojica AJ, Peele ME. Human electrical muscular incapacitation and effects on QTc interval. J Forensic Sci 2017; 62: 1516–1521.

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