Document Detail


The risk of cardiac injury during laparoscopic fundoplication: cardiac troponin I and ECG study.
MedLine Citation:
PMID:  10757571     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Myocardial trauma has been described during gastroesophageal reflux laparoscopic surgery, in association with the proximity of cardiac structures. In addition, specific haemodynamic changes induced by CO2 pneumoperitoneum could exacerbate perioperative cardiac complication even in patients without cardiac risk factors. The aim of this study was to evaluate the influence of gastroesophageal reflux laparoscopic surgery on the perioperative ECG, cardiac troponin I and myocardial enzyme changes. METHODS: Forty-two ASA I-II patients without ischaemic heart disease or combined double-risk factors were studied. Automated ST segment analysis was used intraoperatively. ECG, plasma myocardial enzyme and cardiac troponin I concentrations were reported on arrival in the recovery room (HO), 4 h (H4) and 24 h (H24) postoperatively. RESULTS: Intraoperative ST segment changes occurred in two patients: the first during a hypotensive episode (MAP<55 mmHg; 3/42 patients) and the second during a hypertensive episode (MAP >110 mmHg; 3/42 patients). One case of intraoperative subcutaneous emphysema occurred without ST disturbance. One case of pneumothorax was observed at H0-H4 in another patient without clinical symptoms. Cardiac troponin I and CK-MB were not increased postoperatively. Transaminase concentrations increased (2-fold normal values) in 26/42 patients. In these 26 patients, 7 experienced 5-fold isolated transaminase increase, associated with left hepatic artery section. CONCLUSION: According to perioperative ECG changes and/or specific cardiac troponin I measurements, we did not identify specific myocardial damage following gastroesophageal reflux laparoscopic surgery. Unexpectedly, the incidence of hepatic cytolysis was frequent (62%) and has not previously been reported in the literature.
Authors:
G Boccara; Y Pouzeratte; R Troncin; A Bonardet; A M Boularan; P Colson; C Mann
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  44     ISSN:  0001-5172     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  2000 Apr 
Date Detail:
Created Date:  2000-06-05     Completed Date:  2000-06-05     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  DENMARK    
Other Details:
Languages:  eng     Pagination:  398-402     Citation Subset:  IM    
Affiliation:
Department of Anaesthesiology and Intensive Care B, Medical University of Montpellier, Hospital of Saint-Eloi, France. g-boccara@chu-montpellier.fr
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Creatine Kinase / blood
Electrocardiography*
Female
Fundoplication / adverse effects*
Gastroesophageal Reflux / surgery
Heart Injuries / diagnosis,  etiology*
Humans
Intraoperative Complications
Isoenzymes
Laparoscopy / adverse effects*
Male
Middle Aged
Monitoring, Intraoperative
Myocardium / enzymology,  metabolism
Myoglobin / blood
Postoperative Complications
Troponin I / blood*
Chemical
Reg. No./Substance:
0/Isoenzymes; 0/Myoglobin; 0/Troponin I; EC 2.7.3.2/Creatine Kinase

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