J.Jpn. Surg. Soc.. 81(9): 999-1003, 1980

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Report on the annual meeting

GENESIS AND MANAGEMENT OF CARDIAC ARRHYTHMIAS.―COMPARISON OF MEDICAL AND SURGICAL PROBLEMS

Surgical interventions may aggravate or precipitate arrhythmias. The arrhythmogenic factors include: altered autonomic nerve tones caused by pain, intubation, manipulation of visceral organs,etc.; cardiac effects of anesthetics, muscle relaxants and other drugs; serum electrolyte derangements,especially hypo- or hyperkalemia, due to hemorrhage, transfusion and renal failure; myocardial ischemia caused by hypotension; inadequate ventilation with hypoxia and hypercapnia; hypothermia;and mechanical cardiac injury in open-heart surgery. In surgical patients, these factors develop and subside more rapidly than in medical cases, and hence, resultant arrhythmias usually occur only transiently. However, certain cases develop arrhythmias days or weeks after a surgery. This may (1) be solely dependent on the underlying medical problems, (2) result from postoperative hemodynamic and humoral alterations, or (3) in cases of cardiac surgery, reflect fibrotic changes around incisions and sutures generating arrhythmogenic foci. Principles in the prevention and management of surgical arrhythmias include: recording an electrocardiogram immediately before surgery to identify existing arrhythmias; readjusting the medical treatment, as both insufficient and excessive digitalis medication can be unmasked by surgery: minimizing the use of digitalis and potent antiarrhythmic agents in the operating room: insertion of an electrode catheter especially in cardiac patients: and controlling all the arrhythmogenic factors by a close cooperation of internists, anesthetists and surgeons.

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