뇌지주막하 출혈 후 발생된 심전도 異常

Abstract

Background : Electrocardiogram was one of the routine monitorings not only using for preanesthetic assessment but also in the operation room and ICU. Electrocardiographic changes are reported frequently after subarachnoid hemorrhage. Preanesthetic assessment of ECG abnormalities in the patients with subarachnoid hemorrhage is important. The aim of this study was to investigate the functional significance of ECG changes for perioperative assessment of cardiac function. Methods : For premedication, patients were administered glycopyrrolate 0.2 mg 1 hour prior to induction. Induction was established with pentothal sodium, succinylcholine after precurarization and preoxygenation. N2O/O2 (2：1), isoflurane and pancuronium were administered for maintenance. The monitorings for patients were performed ECG (5 leads), direct atrial pressure, ETCO2, CVP and rectal temperature. Results : ECG abnormalities consisted of T wave abnormalities, ST segment changes, abnormal Q wave, QT interval prolongation, LVH and arrhythmia etc. We analyzed 41 of 108 SAH patients who had ECG abnormalities of neurogenic origin preoperatively. Of these, 46% in T wave, 17% in LVH, 15% in Q wave, 15% in ST segment changes and 7% in the others (CRBBB, PAC, AF) were found. Conclusions : It is concluded that we found a poor relationship between electrocardiographic changes after subarachnoid hemorrhage and evidences of myocardial dysfunction on the echocardiogram. General anesthesia in the patients of the subarachnoid hemorrhage must not be delayed in the patients with ECG abnormalities of neurogenic origin. A preanesthetic cardiac assessment in the patients with ECG abnormalities of cardiogenic origin must be always performed. (Korean J Anesthesiol 1998; 35: 1136∼1141) Key Words: Brain; cerebral aneurysm; subarachnoid hemorrhage. Monitoring; electrocardiogram.