Abstract
“Silent” ischemia may occur during hemodynamic changes accompanying induc tion of anesthesia in patients undergoing coronary bypass surgery and may be detected by continuous monitoring of the ECG. A real-time single-lead ST monitor was developed, validated, and used to detect ischemia during induction of anesthesia in 101 patients (85 men, 16 women; mean age, 61 ±9 years) undergoing bypass surgery. The first 72 patients were unselected, and the last 29) were included if they had stable angina and a positive exercise ECG (≥0.1 mV ST depression) so that lead selection for monitoring could be based on the exercise lest results. Ischermia during anesthesia (ST deviation, >0.1 mV) occurred in 10% of patients (10 of 101) despite routine premedication with nitrates; this percentage was identical in the unselected (7 of 72) and selected (3 of 29) patients, indicating that preoperative exercise-induced ischemia did not predict ischemia during induction of anesthesia. Perioperative Q-wave infarction developed in 5% of patients, but was more common in those with ischemia during anesthesia (2 of 10, 20%) than in those without (3 of 91, 3%; P<0.05). Silent ischemia during anesthesia for coronary bypass surgery can be detected by real-time ECG monitoring of the ST segment and may identify a small group of patients with a relatively high risk of perioperative Q-wave infarction.
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