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Holter ECG monitor General anesthesia Open kidney cancer surgery

Holter ECG monitor Epidural anesthesia General anesthesia Open kidney cancer surgery

Bupivacaine-fentanyl

Holter ECG monitor

Open kidney cancer surgery

General anesthesia

Epidural Anaesthesia

Karolina Dobronska, MD

This study evaluates the incidence of cardiac arrhythmias during the perioperative period in patients undergoing open kidney cancer surgery in the lateral position. All the participants will be randomly allocated to receive general (Group G) or combined epidural/general anaesthesia (Group G/E). The anaesthetic technique is standardized. The Holter monitor will be applied at the evening before the surgery, tracing continuously for a period of 24 hours (7PM-7PM)

Cardiac arrhythmias are a common complication during and after cardio-thoracic surgery. They are also a major source of morbidity and mortality. After general surgery, they usually do not require clinically significant management but the literature on this topic is obsolete. There is no literature data about their incidence during kidney surgery in the lateral position when the bed is scissored so the legs and head are low. The aim of this study was to define what types of arrhythmias are the most common during kidney cancer surgery, their incidence and whether combining general with epidural anesthesia prevents them.

An approval from the Medical University of Warsaw Bioethical Committee has been obtained. Patients need to give written informed consent to participate in the study.

It is anticipated that 50 patients with open kidney cancer surgery performed in the lateral position, under general or combined anesthesia will be enrolled.

A Holter ECG monitor (3-chanel, leads CM5) will be applied at the evening before the surgery, tracing continuously for a period of 24 hours (7PM-7PM).

Patients will be randomly allocated (random permuted blocks within strata) to receive general or combined epidural/general anesthesia. The anesthetic technique is standardized. All the data registered by the Holter ECG monitor will be analyzed and compared with the nursery and anesthesia records.

Cardiac Arrhythmias in Patients Undergoing Kidney Cancer Surgery Depending on the Anaesthesia Method

Evaluation of Cardiac Arrhythmias in Patients Undergoing Kidney Cancer Surgery Depending on the Anaesthesia Method

The investigator evaluates the incidence of cardiac arrhythmias, the type of arrhythmias and whether additional interventions were needed to treat them

Arrhythmias observed:

tachycardia \>100 bpm bradycardia \< 50 bpm pause (P-P interval \> 2 seconds) ventricular extrasystoles (VE) \> 1000/ 24 hours supraventricular extrasystoles (SVE) \>200/24 hours

The investigator evaluates the incidence of cardiac arrhythmias depending on anesthesia method by observing the number and type of arrhythmias and whether additional interventions were needed to treat them

Medical University of Warsaw

M.D.

General anesthesia Holter ECG monitor: 3-chanel, CM5 leads Open kidney cancer surgery: Lateral position

General Anesthesia (G)

General anesthesia Epidural anesthesia: Local anesthetic Holter ECG monitor: 3-chanel, CM5 leads Open kidney cancer surgery: Lateral position

Combined General/Epidural (G/E)

Total

Age, Categorical

Age, Continuous

Sex: Female, Male

Poland

Region of Enrollment

AMERICAN SOCIETY OF ANESTHESIOLOGISTASA (ASA) PHYSICAL STATUS CLASSIFICATION SYSTEM

ASA I A normal healthy patient ASA II A patient with mild systemic disease ASA III A patient with severe systemic disease ASA IV A patient with severe systemic disease that is a constant threat to life ASA V A moribund patient who is not expected to survive without the operation ASA VI A declared brain-dead patient whose organs are being removed for donor purposes

\*The addition of "E" denotes Emergency surgery

Type of Surgery

Dr. Karolina Dobronska

No bradycardia observed in the perioperative period

Tachycardia < 140 bpm before surgery

Tachycardia < 140 bpm during surgery

Tachycardia < 140 bpm after surgery

Bradycardia before surgery

Bradycardia during surgery

Bradycardia after surgery

Bradycardia in the perioperative period

pause > 2s before surgery

pause > 2s during surgery

pause > 2s after surgery

pause > 2s in the perioperative period

SVE before surgery

SVE during surgery

SVE after surgery

SVE in the perioperativ

VE before surgery

VE during surgery

VE after surgery

VE in the perioperative period

Additional intervention needed

General anesthesia Epidural anesthesia: Local anesthetic Holter ECG monitor: 3-chanel, CM5 leads Open kidney cancer surgery: Lateral position General anesthesia

Incidence of Perioperative Cardiac Arrhythmias Evaluated by a Continuous ECG Holter Monitoring in the Perioperative Period

long QTc \> 0.24 s in the perioperative time

arrhythmia before surgery

arrhythmia during surgery

arrhythmia after surgery

QTc long > 0.45s before surgery

QTc long > 0.45s during surgery

QTc long > 0.45s after surgery

QTc long > 0.45s in the perioperative time

arrhythmias analysed: bradycardia, pause \> 2s, supraventricular extrasystoles, ventricular extrasystoles; corrected QT interval (QTc)

The Prevention of Cardiac Arrhythmias Occurence by Epidural Anesthesia Added to General Anesthesia Evaluated by a Number and Type of Arrhythmias Observed

Overall Study

Spots Global Cancer Trial Database for arrhythmia, cardiac