세보플루란을 이용한 완전흡입마취 유도 시 부정맥의 발생률과 위험인자

Abstract

Background : Arrhythmia was occasionally observed during volatile induction and maintenance of anesthesia using sevoflurane. However, since there were few studies related to arrhythmia in volatile induction, we investigated the incidence and the risk factors affecting the occurrence of arrhythmia. Materials and methods : We retrospectively analyzed 995 patients who underwent ear-nose-and-throat surgery with volatile induction at Asan Medical Center. Arrhythmia group and normal rhythm group were divided according to the presence or absence of arrhythmia. Logistic regression analysis was used to determine the risk factors of arrhythmia. Results : Arrhythmia was observed in 271 patients (27%) out of 995 patients. Sinus tachycardia was the most frequent with 186 (66%), junctional rhythm was 51 (18%). Age, ASA classification, hypertension and PR interval of preoperative electrocardiogram were differed between normal rhythm group and arrhythmia group. The incidence of arrhythmia was high in patients who received high concentration of sevoflurane from the beginning (p=0.038). Arrhythmia was more frequent in patients maintained at higher concentration than patients who had lowered concentration after eyelash reflex (p<0.001). Multivariate regression analysis indicated that coronary artery disease and sevoflurane concentration after the loss of the eyelash reflex were independent risk factors for the occurrence of arrhythmia (odds ratio=3.438; 95% confidence interval=1.524-7.754; P=0.003, odds ratio=2.287; 95% confidence interval=1.653-3.165; P<0.001, respectively). Conclusion : This result suggests that coronary artery disease and high concentration of sevoflurane after the loss of eyelash reflex are risk factors of arrhythmia in volatile induction. Concentration control of sevoflurane should be considered with monitoring and preparation of arrhythmia.