PECULIARITIES OF CARBOPNEUMPEROPERITONEUM AT LAPAROSCOPIC OPERATION UNDER CONDITIONS OF RHYTHM DISORDERS AND CONDUCTIVITY OF CARDIAC ACTIVITY

Abstract

The aim of the research – to study the effect of carbopneumoperitoneum on the possibility of laparoscopic surgery in patients with cardiac rhythm disorders and conduction disturbances. We conducted analysis of 940 patients who underwent lapa roscopic surgery. The patients were divided into two groups. The first group included 630 patients (67,0%) with cardiac ar rhythmias; the second group included 310 (33,0%) patients with heart rhythm disturbance that arose during carbopneumoperito neum. In all patients of the first group in the preoperative period, heart rhythm disturbance was observed: sinus tachycardia - 30 (4,8%); sinus bradycardia - 50 (7,9%); paroxysmal tachycardia with a arrow QRS complex - 5 (0,8%); complete blockage of the right leg of the bunch Gis - 12 (1,9%); complete blockage of the left leg of the bunch Gis - 21 (3,3%), AV- blockade of the I degree - 23 (3,7%), the AV- blockade of the II degree Mo bitz I - 12 (1,9%), AV- II degree blockade Mobits II - 8 (1,3%), complete AV- blockade - 5 (0,8%), supraventricular extrasystole - 216 (34,3%), persistent atrial fibrillation - 103 (16,3%), parox ysms of atrial fibrillation - 41 (6,5%), a constant form of atrial flutter - 12 (1,9%), paroxysms of atrial flutter - 4 (0,6%), ven tricular extrasystole - 70 (11,1%), episodes of unstable ventricu lar tachycardia - 10 (1,6%), episodes of sustained ventricular tachycardia - 8 (1,3%). All patients also observed an increase in the dispersion of the QT interval – 61,4±1,9 ms. In the second group, during carbopneumoperitoneum, car diac arrhythmias appeared during surgical interventions with various risks of its development: with a low risk of development (laparoscopic appendectomy) occurred in the form of episodes of sinus bradycardia (27,8%), ventricular extrasystole (27,8%), supraventricular extrasystole (16,7%), the variance of the interval was - QT 61,2±1,0 ms; with an mediunrisk of developing heart rhythm disturbances (laparoscopic cholecys tectomy, transabdominal prepperitonealenlovideogernioplasty) - ventricular extrasystole (37,5%), episodes of sinus bradycardia (29,5%), supraventricular extrasystole (14,3%), QT dispersion 64,9±1,0 ms; with a high risk of developing heart rhythm dis turbances (laproscopichernioplasty of hernias of the diaphragm, laparoscopic operation on the colon, simultaneous laparoscopic surgery) - ventricular extrasystole (23,6%), episodes of sinus bradycardia (20,1%), supraventricular extrasystole (15,8%), dispersion QT interval – 72,3±1,3 ms. When performing laparoscopic surgery with a high risk of heart rhythm disturbance, arrhythmias that are potentially malignant (supraventricular extrasystole, including early supraventricular extrasystole (type “R on T”), unstable VT, more often than in patients with low and medium risk AF), and malignant (persistent VT, including polymorphic and pir ouette tachycardia), which can cause critical hemodynamic disorders and can transform into FS or asystole. Also, in such patients, episodes of AV blockade of I degree, episodes of AV blockade of II degree Mobitz I, episodes of AV blockade of II degree Mobitz II, episodes of complete AV block are more often recorded. Patients possibly holding laparoscopic surgery after a course of antiarrhythmic treatment and taking into account the risk of cardiac arrhythmias, where intraoperative intra-abdominal pres sure plays a major role. Carbopneumoperitoneum increases the risk of sinus brady cardia (up to 26,5% of cases), all episodes during CO2 insuf flation. The incidence of ventricular extrasystole was 2 times higher than that of supraventricular extrasystole (31,0% and 15,2% respectively). Including early ventricular extrasysto les (type “R on T”) - in 3,8% of cases. Increases the likeli hood of occurrence of both unstable (4,5%) and stable (2,6%) ventricular tachycardia, including “pirouette” -tachycardia (2,9%). There is also an increased risk of episodes of second degree AV-blockade Mobitz II (1,6%) and episodes of com plete AV-blockade (1,0%).