The risk of cardiac injury during laparoscopic fundoplication: cardiac troponin I and ECG study

Background: Myocardial trauma has been described during gastroesophageal re flux laparoscopic surgery, in association with the proximity of cardiac str uctures. In addition, specific haemodynamic changes induced by CO2 pneumope ritoneum could exacerbate perioperative cardiac complication even in patien ts without cardiac risk factors. The aim of this study was to evaluate the influence of gastroesophageal reflux laparoscopic surgery on the perioperat ive ECG, cardiac troponin I and myocardial enzyme changes. Methods: Forty-two ASA I-II patients without ischaemic heart disease or com bined double-risk factors were studied. Automated ST segment analysis was u sed intraoperatively. EGG, plasma myocardial enzyme and cardiac troponin I concentrations were reported on arrival in the recovery room (H0), 4 h (H4) and 24 h (H24) postoperatively. Results: Intraoperative ST segment changes occurred in two patients: the fi rst during a hypotensive episode (MAP<55 mmHg; 3/42 patients) and the secon d during a hypertensive episode (MAP >110 mmHg; 3/42 patients). One case of intraoperative subcutaneous emphysema occurred without ST disturbance. One case of pneumothorax was observed at H0-H4 in another patient without clin ical symptoms. Cardiac troponin I and CKMB were not increased postoperative ly. Transaminase concentrations increased (2-fold normal values) in 26/42 p atients. In these 26 patients, 7 experienced 5-fold isolated transaminase i ncrease, associated with left hepatic artery section. Conclusion: According to perioperative ECG changes and/or specific cardiac troponin I measurements, we did not identify specific myocardial damage fol lowing gastroesophageal reflux laparoscopic surgery. Unexpectedly, the inci dence of hepatic cytolysis was frequent (62%) and has not previously been r eported in the literature. (C) Acta Anaesthesiologica Scandinavica 44 (2000).