Chapter 34
- Electrocardiography
- Zaharia Hillel
- Daniel M. Thys
The intraoperative use of the electrocardiogram (ECG) has markedly
developed over the past several decades.[1]
Originally,
this monitor was used during anesthesia for the detection of arrhythmias in high-risk
patients.[2]
At that time, standard limb lead II
was displayed, because its electrical axis parallels the electrical axis of the heart
and the P wave is usually easily observed. Since then, the importance of ECG as
a standard monitor has been recognized, and its use while conducting any anesthetic
regimen is now recommended.[3]
Beyond the usefulness
of the ECG for the recognition of intraoperative arrhythmias, one of the major indications
for electrocardiographic monitoring is the intraoperative diagnosis of myocardial
ischemia.[4]
Despite widespread attempts at prevention,
coronary artery disease continues to be a major health problem in the United States.
Some patients undergoing different types of surgical procedures have significant
coronary artery disease, and the ECG should be used to identify myocardial ischemia
and to recognize arrhythmias. With many patients coming to surgery with pacemakers
in place, the ECG also enables the physician to follow the function of the device
during the surgical procedure. Since the first use of the ECG during anesthesia,
the technology available to the anesthesiologist has become considerably more sophisticated.
This chapter describes some of the newer developments in the use and interpretation
of the ECG.
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