Frequency of electrocardiographic changes indicating myocardial ischemia during elective cesarean delivery with regional and general anesthesia: detection based on continuous Holter monitoring and serum markers of ischemia

Study ObjectiveTo determine the frequency of electrocardiographic (ECG) changes and to assess the occurrence of myocardial ischemia during elective cesarean delivery with either regional or general anesthesia.DesignRandomized, prospective, single-blinded clinical trial.SettingLarge referral hospital.Patients40 ASA physical status I and II term parturients.InterventionsPatients were divided randomly into two groups as follows: the regional anesthesia group (group 1, n = 20) and the general anesthesia group (group 2, n = 20).MeasurementsIn each case, continuous ECG was done using a 7-lead Holter monitor in the operating room, continuing for 24 hours after surgery. All Holter traces were analyzed by a study-blinded cardiologist. Blood samples were collected preoperatively (baseline) and at one, 5, and 24 hours postoperatively. Serum troponin T, creatinine kinase-MB, and myoglobin levels were measured.Main ResultsTwo patients in group 1 (10%) and one patient in group 2 (5%) showed one mm ST-segment depression for two to 5 minutes. In all 40 cases, troponin T levels were in the normal range at all time points studied. In both groups, mean serum creatinine kinase-MB and myoglobin levels at one and 5 hours postoperatively were significantly higher than at baseline (P < 0.05). These high CK-MB and myoglobin levels were returned to normal ranges at the end of the study period; none of these women showed ST-segment changes.ConclusionThe ST-segment changes are not frequent in healthy women undergoing elective cesarean delivery during either regional or general anesthesia, and we found no evidence of myocardial injury.