Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942004000200006
Brazilian Journal of Anesthesiology
Scientific Article

Disritmias cardíacas e alterações do segmento ST em idosos no perioperatório de ressecção transuretral da próstata sob raquianestesia: estudo comparativo

Cardiac arrhythmias and ST changes in the perioperative period of elderly patients submitted to transurethral prostatectomy under spinal anesthesia: comparative study

Beatriz Lemos da Silva Mandim; Renato Enrique Sologuren Achá; Neuber Martins Fonseca; Fabiano Zumpano

http://dx.doi.org/10.1590/S0034-70942004000200006 Braz J Anesthesiol, vol.54, n2, p.190-203, 2004
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Resumo

JUSTIFICATIVA E OBJETIVOS: Idosos representam 25% do total dos pacientes cirúrgicos. Muitos pacientes com doença arterial coronariana (DAC) apresentam eletrocardiograma (ECG) pré-operatório normal, e alta incidência de infarto agudo do miocárdio (IAM) silencioso na 1ª semana de pós-operatório. As disritmias aumentam com a idade, sendo observadas extrassístoles supraventriculares (ESSV) e ventriculares (ESV), fibrilação atrial e distúrbios da condução intraventricular. O objetivo deste estudo foi avaliar a prevalência de disritmias cardíacas e de alterações do segmento ST no perioperatório através do Sistema Holter em pacientes idosos submetidos à cirurgia de ressecção transuretral da próstata (RTU) e herniorrafia inguinal sob raquianestesia (controle). MÉTODO: Foram avaliados 21 pacientes com idades entre 65 e 84 anos submetidos a RTU da próstata e 16 pacientes com idades entre 65 e 86 anos, submetidos à herniorrafia inguinal, sob raquianestesia. Avaliação pelo Sistema Holter no pré-operatório (12 horas), intra-operatório (3 horas) e pós-operatório (12 horas). RESULTADOS: A prevalência de extrassístoles supraventriculares (ESSV) entre os grupos RTU e controle foi, no pré-operatório 85,7% vs. 93,7%, no intra-operatório 85,7% vs. 81,2% e no pós-operatório 76,2% vs. 100%. As extrassístoles ventriculares (ESV) tiveram prevalência de 76,2% vs. 81,2% no pré, 80,9% vs. 68,7% no intra e 80,9% vs. 81,2% no pós-operatório. A prevalência de alterações do segmento ST entre os grupos RTU e controle foi, no pré-operatório 19% vs. 18,7%, no intra-operatório 4,7% vs. 18,7% e no pós-operatório de 14,3% vs. 18,7%, sem significância estatística. CONCLUSÕES: Os paciente idosos apresentam alta prevalência de ESSV e ESV. O número total de ESSV e ESV, e alterações do segmento ST, presentes no período pré-operatório, não foi alterado pela cirurgia de ressecção transuretral da próstata, bem como pela herniorrafia inguinal, nos períodos intra e pós-operatório.

Palavras-chave

CIRURGIA, CIRURGIA, COMPLICAÇÕES, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Elderly account for 25% of surgical patients. Several patients with arterial heart disease have normal preoperative ECG and a high incidence of silent myocardial acute infarction in the first postoperative week. Arrhythmias increase with age and supraventricular and ventricular premature complexes, atrial fibrillation and intraventricular conduction abnormalities are observed. This study aimed at evaluating the prevalence of perioperative arrhythmias and ST changes through Holter System in elderly patients submitted to transurethral prostatectomy and inguinal hernia repair under spinal anesthesia. METHODS: Participated in this study 21 patients aged 65 to 84 years submitted to transurethral prostatectomy (TUP) and 16 patients aged 63 to 86 years submitted to inguinal hernia repair under spinal anesthesia. Monitoring with Holter System was performed in the preoperative (12 hours), intraoperative (3 hours) and postoperative (12 hours) periods. RESULTS: The prevalence of supraventricular premature complex was 85.7% vs. 93.7% in the preoperative period, 85.7% vs. 81.2% in the intraoperative and 76.2% vs. 100% in the postoperative period, respectively for groups TUP and control. The prevalence of ventricular premature complex was 76.2% vs. 81.2% in the preoperative period, 80.9% vs. 68.7% in the intraoperative period, and 80.9% vs. 81.2% in the postoperative period, respectively for groups TUP and control. The prevalence of ST changes was 19% vs. 18.7% in the preoperative period, 4.7% vs. 18.7% in the in the intraoperative period, and 14.3% vs. 18.7% in the postoperative period between groups TUP and control, without statistical significance. CONCLUSIONS: Elderly patients have a high prevalence of supraventricular and ventricular cardiac arrhythmias. The total number of preoperative arrhythmias and ST changes was not changed as a function of transurethral prostatectomy surgery or inguinal hernia repair, in the intra and postoperative periods.

Keywords

ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, COMPLICATIONS, SURGERY, SURGERY

Referencias

Priebe HJ. The aged cardiovascular risk patient. Br J Anaesth. 2000;85:763-778.

Oskvig RM. Special problems in the elderly. Chest. 1999;115(^s5):158S-164S.

Costa EFA, Porto CC, Almeida JC. Semiologia do Idoso, em: Porto CC - Semiologia Médica. 2001:165-197.

Muravchick S. Anesthesia for the Elderly. Anesthesia. 2000:2140-2156.

Manhães WL. O Risco e o Prognóstico na Anestesia. Anestesiologia Princípios e Técnicas. 1997:80-93.

Shipton EA. The peri-operative care of the geriatric patient. S Afr Med J. 1983;63:855-860.

Haagensen R, Steen PA. Perioperative myocardial infarction. Br J Anaesth. 1988;61:24-37.

Cohn PF, Lawson WE. Characteristics of silent myocardial ischemia during out-of-hospital activities in asymptomatic angiographically documented coronary artery disease. Am J Cardiol. 1987;59:746-749.

Nademanee K, Intarachot V, Singh PN. Characteristics and clinical significance of silent myocardial ischemia in unstable angina. Am J Cardiol. 1986;58:26B-33B.

Tarhan S, Moffitt EA, Taylor WF et al. Myocardial infarctation after general anaesthesia. JAMA. 1972;220:1451-1454.

Steen PA, Tinker JH, Tarhan S. Myocardial reinfarctation after anesthesia and surgery. JAMA. 1978;239:2566-2570.

Plumlee JE, Boettner RB. Myocardial infarctation during and following anesthesia and operation. South Med J. 1972;65:886-889.

Rao TL, Jacobs KH, El-Etr. Reinfarctation following anesthesia in patients with myocardial infarctation. Anesthesiology. 1983;59:499-505.

Friedmann AA, Grindler J. Aplicações clínicas do eletrocardiograma no idoso. Rev Soc Cardiol Estado de São Paulo. 1999;9:286-292.

Bertrand CA, Steiner NV, Jameson AG. Disturbances of cardiac rhythm during anesthesia and surgery. JAMA. 1971;216:1615-1617.

Santos SCM, Wajgarten M, Serrok-Azul JB. Arritmias no idoso. Rev Soc Cardiol Estado de São Paulo. 1998;8:117-126.

Fujino M, Okada R, Arakawa K. The relationship of aging to histological changes in the conduction system of the normal human heart. Jpn Heart J. 1983;24:13-20.

Lakata EG. Diminished beta-adrenergic modulation of cardiovascular function in advanced age. Cardiol Clin. 1986;4:185-200.

Wyatt MG, Stower MJ, Smith PJ. Prostatectomy in the over 80 year-old. Br J Urol. 1989;64:417-419.

Mudd DG, Deans GT, Lee BG. Prostatectomy in a district hospital. J R Coll Surg Edinb. 1990;35:365-368.

Deedwania PC, Carbajal E. Silent myocardial ischaemia: A clinical perspective. Arch Intern Med. 1991;151:2373-2382.

Vale NB, Simonetti MPB. Farmacologia dos Anestésicos Locais. Tratado de Anestesia Raquidiana. 2001:22-35.

Bratanow N, Atlee JL. Perioperative arrhythmia's. Seminars in Anesthesia. 1996;15:122-131.

Atlee JL. Perioperative Cardiac Dysrhythmias. Cardiac Dysrhythmias and Anesthesia: Mechanisms, Recognition, Management. 1985:101-113.

Wajngarten M, Grupi C, Bellotti G. Frequency and significance of cardiac rhythm disturbances in healthy elderly individuals. J Electrocardiol. 1990;23:171-176.

Shiraishi I, Takamatsu T, Minamikawa T. Quantitative histological analysis of human sinoatrial node during growth and aging. Circulation. 1992;85:2176-2184.

Tammaro AE, Ronzoni D, Bonaccorso O et al. Arrhythmia's in the elderly. Minerva Med. 1983;74:1313-1318.

Hashiba K. Arrhythmia's in the elderly. Nippon Ronen Igakkai Zasshi. 1989;26:101-110.

Wakida Y, Okamoto Y, Iwa T. Arrhythmias in centenarians. Pacing Clin Electrophysiol. 1994;17:2217-2221.

Waktare JE, Camm AJ. Acute treatment of atrial fibrillation why and when to maintain sinus rhythm. Am J Cardiol. 1998;81:3C-15C.

Brodsky M, Wu D, Denes P. Arrhythmias documented by 24 hour continuous electrocardiographic monitoring in 50 male medical students without apparent heart disease. Am J Cardiol. 1977;39:390-395.

Rasmussen V, Jensen G, Schnohr P. Premature ventricular beats in healthy adult subjects 20 to 79 years of age. Eur Heart J. 1985;6:335-341.

Dietz A, Walter J, Bracharz H. Cardiac arrhythmias in active elderly persons-age dependence of heart rate and arrhythmias. Z Kardiol. 1987;76:89-94.

Kuner J, Enescu V, Utsu F et al. Cardiac arrhythmia's during anesthesia and surgery. JAMA. 1952;150:1212-1216.

Mangano DT, Browner WS, Hollenberg M et al. Association of perioperative myocardial ischaemia with cardiac morbidity and mortality on men undergoing noncardiac surgery. The study of perioperative ischemia research group. N Engl J Med. 1990;323:1781-1788.

Marshall BE, Wyche Jr MQ. Hypoxemia during and after anesthesia. Anesthesiology. 1972;37:178-209.

Raby KE, Goldman L, Creager MA. Correlation between preoperative ischemia and major cardiac events after peripheral vascular surgery. N Engl J Med. 1989;321:1296-1300.

Landesberg G, Luria MH, Cotev S. Importance of long-duration postoperative ST-segment depression in cardiac morbidity after vascular surgery. Lancet. 1993;341:715-719.

Evans JW, Singer M, Chapple CR. Haemodynamic evidence for peri-operative cardiac stress during transurethral prostatectomy. Br J Urol. 1991;67:376-380.

Dobson PM, Caldicott LD, Gerrish SP. Changes in haemodynamic variables during transuretheral resection of the prostate: comparison of general and spinal anaesthesia. Br J Anaesth. 1994;72:267-271.

Edwards ND, Callaghan LC, White T. Perioperative myocardial ischaemia in patients undergoing transurethral surgery: a pilot study comparing general with spinal anaesthesia. Br J Anaesth. 1995;74:368-372.

Shalev M, Richter S, Kessler O. Long-term incidence of acute myocardial infarction after open and transurethral resection of the prostate for benign prostatic hyperplasia. J Urol. 1999;161:491-493.

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