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The journal «ONCOSURGERY» 2012, Vol.4, No 3

Specifics of perioperative management for abdominal surgery in cancer patients with cardiac co-morbidity

Khoronenko VE, Shemetova MM, Aleksin AA

PA Herzen Moscow Cancer Research Institute, Moscow, Russia
Contact: Shemetova MM, e-mail:

The objective. To develop the algorithm for selection of methods and components of anesthesia, minimally affecting rhythm and cardiac conducting system (CCS) in patients with high risk of perioperative arrhythmias.

Material and methods. 120 patients (64.1±7.65 y.o.), receiving cardiotropic therapy for cardiovascular disorders, who underwent surgery for malignant abdominal tumors. According anesthesia methods patients were randomized for 4 groups: group 1 (n=29) received multimodal intravenous general anesthesia (IGA), group 2 – (n=30) – inhalational anastesia (IA) with sevoflurane, group 3 – (n=31) – combined epidural anesthesia and IGA, group 4 (n=30) – combined EА and IА. The influence of anesthesia components on rhythm and CCS was assessed by results of continuous electrocardiogram monitoring (Holter).

Results. All patients had changes in structure of cardiac rhythm For group 1 there was increase of ectopic activity: increase of supraventricular premature beat (SPB) for 14.9 times, ventricular premature beat (VPB) – for 4.9 times (p<0,05), requiring correction in 7/29 patients. For other groups following changes were observed: in group 2 increase of SPB and VPB number for 3.6 and 6.3 times, respectively, in groups 3 and 4 – 3.9 and 3.8 times, respectively, impairment of cardiac impulse conduction was maximal in group 3 and was manifested in increase of number of pause during intraoperative period, requiring specific correction. There were no post-operative complications related to disturbance of rhythm and cardiac conduction.

Conclusion. The selection of anesthesia for high risk of perioperative arrythmias are determined by initial cardiac status of patient and the pattern of arrythmogenic activity of anesthesia components. Multimodal IGA is preferred for initial disorders of conduction. Sympathetic epidural blocks combined with IGA and IA are indicated for patients with tachysystols. Sevoflurane has not significant influence on rhythm and CCS.

KEY WORDS: perioperative arrhythmia, anesthesia in patients with high cardiovascular risk, surgery, cardiotropic therapy.

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