ELECTROCARDIOGRAPHIC MONITORING IN HEALTHY-YOUNG ADULT OUTPATIENTS - MANDATORY OR OPTIONAL

Purpose: To determine the incidence and duration of ECG abnormalities in healthy adults during short duration outpatient surgery and their r elationship to important clinical events, Method: In 381, ASA Class I, day surgery patients undergoing short surgical procedures the ECG was monitored prospectively for evidence of abnormalities. The attending anaesthetist administered the anaesthetic and made all clinical decisi ons while relying on routine monitors (ECG, oximeter,BP capnometer, ox ygen analyser, low pressure alarm and anaesthetic gas monitors), Intra -operative events of clinical significance (e.g., light anaesthesia, r egurgitation, coughing, hypotension, arteria[ desaturation, hiccoughs etc), ECG abnormalities and their duration were documented. Results: E lectrocardiographic abnormalities were detected in 21% of patients as follows: sinus tachycardia (11%), artifacts (7%), premature atrial con tractions (1.6%), lead disconnects (1%), sinus bradycardia (0.5%) and premature ventricular contractions (0.3%). All abnormalities resolved spontaneously within three minutes, Intra-operative incidents of conse quence occurred in only 2.6%: light anaesthesia (5), arterial desatura tion > 5% (2), hypotension (1), hiccough(1)and regurgitation (1). All incidents were detected clinically and by pulse oximetry. The ECG did not detect any of the incidents and was normal during the events. Conc lusion: Routine ECG monitoring did not detect intra-operative incident s in healthy adults during short outpatient procedures, Detected ECG a bnormalities were benign and resolved spontaneously within three minut es, Firm conclusions as to the safety implications of withdrawing ECG monitoring cannot be drawn from this study, Guidelines may need to be reviewed to determine whether ECG monitoring in such cases should be o ptional rather than mandatory.