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Canadian Journal of Anaesthesia

, Volume 45, Issue 5, pp 424–428 | Cite as

Electrocardiographic monitoring in healthy young adult outpatients: mandatory or optional?

  • Ibrahim Zabani
  • Himat Vaghadia
  • Colin R. Chilvers
  • Pamela M. Merrick
Reports of Investigation
  • 131 Downloads

Abstract

Purpose

To determine the incidence and duration of ECG abnormalities in healthy adults during short duration outpatient surgery and their relationship to important clinical events.

Method

In 381, ASA Class I, day surgery patients undergoing short surgical procedures the ECG was monitored prospectively for evidence of abnormalities. The attending anaesthetist administered the anaesthetic and made all clinical decisions while relying on routine monitors (ECG, oximeter, BR capnometer, oxygen analyser, low pressure alarm and anaesthetic gas monitors). Intra-operative events of clinical significance (e.g., light anaesthesia, regurgitation, coughing, hypotension, arterial desaturation, hiccoughs etc), ECG abnormalities and their duration were documented.

Results

Electrocardiographic abnormalities were detected in 21 % of patients as follows: sinus tachycardia (11 %), artifacts (7%), premature atrial contractions (1.6%), lead disconnects (1%), sinus bradycardia (0.5%) and premature ventricular contractions (0.3%). All abnormalities resolved spontaneously within three minutes. Intra-operative incidents of consequence occurred in only 2.6%: light anaesthesia (5), arterial desaturation > 5% (2), hypotension (1), hiccough (1) and régurgitation (1). All incidents were detected clinically and by pulse oximetry. The ECG did not detect any of the incidents and was normal during the events.

Conclusion

Routine ECG monitoring did not detect intra-operative incidents in healthy adults during short outpatient procedures. Detected ECG abnormalities were benign and resolved spontaneously within three minutes. Firm conclusions as to the safety implications of withdrawing ECG monitoring cannot be drawn from this study. Guidelines may need to be reviewed to determine whether ECG monitoring in such cases should be optional rather than mandatory.

Keywords

Pulse Oximeter Sinus Bradycardia Light Anaesthesia Electrocardiographic Monitoring Arterial Desaturation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif

Déterminer l’incidence et la durée des anomalies de l’ECG chez des adultes en bonne santé durant des chirurgies ambulatoires de courte durée, et la relation entre ces anomalies et des événements cliniques importants.

Méthode

Chez 381 patients de chirurgie ambulatoire, de classe I de l’ASA, subissant des procédures chirurgicales courtes, l’ECG a été monitoré de façon prospective à la recherche d’anomalies. L’anesthésiste responsable du patient administrait l’anesthésie et prenait toutes les décisions cliniques selon les informations fournies par les moniteurs usuels, soit l’ECG, le saturomètre, la mesure de la pression artérielle, le capnomètre, l’oxymètre, l’analyseur de gaz anesthésiques et le système d’alarme de basse pression. On a documenté les anomalies à l’ECG et leur durée, de même que les événements peropératoires ayant une signification clinique (vg anesthésie légère, régurgitation, toux, hypotension, désaturation, hoquet, etc.)

Résultats

Des anomalies électrocadiographiques ont été détectées chez 21 % des patients: tachycardie sinusale 11%, artefacts 7%, extrasystoles auriculaires 1.6%, déconnection des électrodes 1%, bradycardie sinusale 0.5% et extrasystoles ventriculaires 0.3%. Toutes les anomalies se sont corrigées spontanément en moins de trois minutes. Des incidents peropératoires significatifs sont survenus dans 2.6% des cas seulement: anesthésie légère 5 patients, désaturation de ≥ 5% 2 patients, hypotension I patient, hoquet I patient et régurgitation I patient. Tous les incidents ont été détectés diniquement et par le saturomètre. L’ECG est demeuré normal durant tous ces incidents et n’a pas permis d’en détecter un seul.

Conclusion

Le mon’rtorage de routine de l’ECG n’a pas permis de détecter d’incidents peropératoires chez des adultes en bonne santé opérés en chirurgie ambulatoire pour des procédures courtes. Les anomalies détectées étaient bénignes et se sont toutes résolues en deçà de 3 minutes. Des conclusions définitives concernant les implications quant à la sécurité de cesser le monitorage de l’ECG ne peuvent être tirées de cette étude. Les lignes de conduite pourraient être revues et, dans ces cas, l’ECG pourrait devenir facultatif plutôt qu’essentiel.

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Copyright information

© Canadian Anesthesiologists 1998

Authors and Affiliations

  • Ibrahim Zabani
    • 1
  • Himat Vaghadia
    • 1
    • 2
  • Colin R. Chilvers
    • 1
  • Pamela M. Merrick
    • 1
  1. 1.Section of Ambulatory Anaesthesia, Department of Anaesthesia, Vancouver Hospital and Health Sciences CentreUniversity of British ColumbiaVancouverCanada
  2. 2.The Department of Health Care and EpidemiologyUniversity of British ColumbiaVancouverCanada

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