全身麻酔下の婦人科手術によって誘発される心電図変化　アトロピン前投薬の有無による比較

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  • Effect of atropine premedication on ECG changes provoked by gynecological surgery under inhalational anesthesia.
  • アトロピン前投薬の有無による比較

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ECG pattern changes provoked by gynecological surgery were studied in 62 anesthetized patients. The subjects were divided into two groups : 1) 40 patients premedicated without atropine, and 2) 22 patients premedicated with atropine. Anesthesia was maintained with inhalation of nitrous oxide, oxygen, and sevoflurane. The operation were mainly total abdominal hysterectomy and salpingo-oophorectomy. In the group without atropine, the factors that provoked ECG changes during the surgery were skin disinfection with 10% povidone iodine and incision, traction of the uterus, dissection of the ovarian ligament and the structures surrounding the uterus, especially in the vicinity of the sacrouterine ligament and manipulation of the region adjacent to the dome of the vagina. The ECG changes provoked by stimulation were bradycardia, P wave abnormality and type I and II A-V block (Mobitz type I). In 7 patients, administration of intravenous atropine was necessary because of an abrupt decrease in heart rate and blood pressure. The ECG changes detected indicated abnormal supraventricular conduction, which was thought to be due to strong vagal stimulation in the present setting. In the group premedicated with atropine, these ECG changes were significantly less common. The afferent route of nervous conduction from the gynecologic organs to the vagal cardiac branches is also discussed. [Adv Obstet Gynecol 47 (5); 736-743, 1995 (H7. 9)]

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