Anesthesia: Essays and Researches  Login  | Users Online: 752 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Home | About us | Editorial board | Ahead of print | Search | Current Issue | Archives | Submit article | Instructions | Copyright form | Subscribe | Advertise | Contacts


 
Table of Contents  
LETTER TO EDITOR
Year : 2011  |  Volume : 5  |  Issue : 2  |  Page : 244-245  

Rare artifacts mimicking sinus tachycardia in a case of vaginal hysterectomy with situs inversus totalis


1 Department of Anesthesiology and Intensive Care, GianSagar Medical College and Hospital, Banur, Patiala, Punjab, India
2 Department of Obstetrics and Gynecology, GianSagar Medical College and Hospital, Banur, Patiala, Punjab, India

Date of Web Publication9-Apr-2012

Correspondence Address:
Sukhminder Jit Singh Bajwa
Department of Anaesthesiology and Intensive Care, GianSagar Medical College and Hospital, Ram Nagar, Banur, Punjab
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0259-1162.94799

Rights and Permissions

How to cite this article:
Bajwa SJ, Bajwa SK, Kaur J, Singh A. Rare artifacts mimicking sinus tachycardia in a case of vaginal hysterectomy with situs inversus totalis. Anesth Essays Res 2011;5:244-5

How to cite this URL:
Bajwa SJ, Bajwa SK, Kaur J, Singh A. Rare artifacts mimicking sinus tachycardia in a case of vaginal hysterectomy with situs inversus totalis. Anesth Essays Res [serial online] 2011 [cited 2019 Jun 17];5:244-5. Available from: http://www.aeronline.org/text.asp?2011/5/2/244/94799

Sir,

The introduction of modern monitoring gadgets based on ever improving technology has made the life of the anesthesiologist and intensivist fairly easy and comfortable. But the rare pitfalls and shortcomings due to the inherent electronic limitations of these monitors can sometimes prove hazardous in the interpretation of the various vital parameters. [1] The most commonly observed artifacts are of electrocardiogram (ECG) interpretation which can exhibit any type of arrhythmia or ST-T wave changes and the source of these artifacts can be internal (physiological) or external (non-physiological). [2],[3],[4] The interpretation can be so difficult sometimes that even an experienced anesthesiologist has to apply all his clinical knowledge and acumen to correctly identify the type of artifact as happened in the present case. [5]

A 49-year-old postmenopausal female with an established diagnosis of third-degree uterine prolapse and situsinversuswas posted for trans-abdominal hysterectomy and was administered epidural anesthesia with 17 ml of 0.75% ropivacaine and 60 μg of dexmedetomidine. Surgery was initiated after complete establishment of sensory block up to T-5 level. In the midst of the surgical procedure, the heart rate of the patient decreased to 46/ min. Simultaneously, the non-invasive blood pressure (BP) measured was 130/88 mmHg and we administered 0.3 mg of atropine as a prophylactic measure to rectify the bradycardia. We suddenly observed a display of sinus tachycardia on the monitor's ECG waveform which correlated well with the pulse oximetry waveform (SpO 2) but not with the digital readings [Figure 1]. As the patient had situsinversus with dextrocardia, we got concerned about all the potential cardiac complications. Both the peripheral pulses and heart rate correlated with the digital readings of the monitor and the patient was asymptomatic. Thereafter, on careful analysis of the parameters on the monitor once again, we observed a slightly slower sweep cycle of the waveform of both ECG and SpO 2 as the waveform speed was changed automatically from 25 ms to 12.5 ms [Figure 2]. Most probably this must have occurred when we pressed the blood pressure knob to measure the stat BP. After this initial rectification, the artifact waveform could not be reproduced on repeated attempts and the entire surgical period remained uneventful.
Figure 1: The false picture of sinus tachycardia on the ECG and SpO2 waveform not correlating with the digital reading

Click here to view
Figure 2: The real corrected ECG and SpO2 waveform matching with the digital reading

Click here to view


The electronic devices for continuous monitoring are liable to get damaged by the moisture, dust, fluctuation of the voltages, indiscriminate use and irregular servicing which can alter the values of the parameters and put the patient at risk of unwanted and unnecessary interventions. Though these monitors become available for safe use after passing so many astringent industrial tests such incidents are liable to push the naive anesthesiologist and the intensivist to press the panic button. [6],[7] These therapeutic interventions can unnecessarily enhance the risks for developing complications, especially in patients suffering from various other pre-op co-morbidities. [2]

Situs inversus totalis and dextrocardia can be associated with congenital cardiac lesions such as ventricular septal defect, atrial septal defect, pulmonary stenosis, tetralogy of Fallot, tricuspid atresia and single ventricle, which can have various anesthetic implications. The risks of developing arrhythmias and cardiovascular complications are quite high in this subset of patients as compared to the general population. [8],[9],[10]

In the literature there are numerous reported artifacts during monitoring, resulting from offset potential, poor polarization, amplitude variations, differences in the impedance, stray currents through cables, voltage fluctuations and filtering defects in the monitor, frequency mismatching of the various devices, and so on. [2],[11],[12],[13] The artifacts we encountered occurred solely due to some electronic snag in the monitor which must have been activated during the pressing of the blood pressure knob. Later on, it was found that the monitor was due for service since seven months and was withdrawn from the operation theatre and a complete check-up was done the next day by the engineer along with the servicing Till now, we had not faced any such problem in any of the operation theatres and intensive care unit and a team of biomedical engineer and a senior anesthesia technician has now been assigned the responsibility of getting the service done for all the electronic gadgets at least 15-30 days earlier than the recommended date.

To conclude, it is recommended that the anesthesiologist and the intensivist should always rely on their personal experience, knowledge and clinical acumen to counter any real or pseudo complications. They should make use of all their vital senses which can make them alert and vigilant in the operation theatre and intensive care unit to deal with any potential complication instead of relying solely on the electronic monitoring gadgets. The age-old proverb stands so true even in the modern electronic times i.e. 'Treat the patient and not the monitor'.

 
   References Top

1.Drew BJ. Pitfalls and artifacts in electrocardiography. CardiolClin 2006;24:309-15.  Back to cited text no. 1
    
2.Chase C, Brady WJ. Artifactual electrocardiographic change mimicking clinical abnormality on the ECG. Am J Emerg Med 2000;18:312-6.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Srikureja W, Darbar D, Reeder GS. Tremor induced ECG artifact mimicking ventricular tachycardia. Circulation 2000;102:1337-8.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Garvey JL.ECG techniques and technologies. Emerg Med Clin North Am 2006;24:209-25.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Knight BP, Pelosi F, Michaud GF, Strickberger SA, Morady F. Physician interpretation of electrocardiographic artifact that mimics ventricular tachycardia. Am J Med 2001;110:335-8.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Knight BP, Pelosi F, Michaud GF, Strickberger SA, Morady F. Clinical consequences of electrocardiographic artifact mimicking ventricular tachycardia. N Engl J Med 1999;341:1270-4.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Bronzetti G, Canzi A, Picchio FM, Boriani G. Fluttering waves in electrocardiograms recorded in neonatal intensive care unit. Int J Cardiol 2003;92:299-301.  Back to cited text no. 7
[PUBMED]  [FULLTEXT]  
8.Song JY, Rana N, Rottman CA. Laparoscopic appendicectomy in a female patient with situsinversus: Case report and literature review. JSLS 2004;8:175-7.  Back to cited text no. 8
    
9.Anoop P, Kumar V, Sasidharan CK. Situs inverses totalis with complex cardiac malformations in GoldenharSyndrome. Kuwait Med J 2004;36:212-3.  Back to cited text no. 9
    
10.Mathew PJ, Sadera GS, Sharafuddin S, Pandit B. Anaesthetic considerations in Kartagener's syndrome - a case report. Acta Anaesthesiol Scand 2004;48:518-20.  Back to cited text no. 10
[PUBMED]  [FULLTEXT]  
11.Brande FV, Martens P. A false positive arrhythmia on electrocardiogram induced by a cell phone. Eur J Emerg Med 2003;10:357-60.  Back to cited text no. 11
[PUBMED]  [FULLTEXT]  
12.Marples IL. Transcutaneous electrical nerve stimulation (TENS): An unusual source of electrocardiogram artifact. Anaesthesia 2000;55:719-20.  Back to cited text no. 12
[PUBMED]  [FULLTEXT]  
13.Bonvini RF, Camenzind E. Electrocardiogram artifacts caused by an abdominal electro stimulator. Med J Aust 2004;181:455.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References
    Article Figures

 Article Access Statistics
    Viewed1009    
    Printed19    
    Emailed0    
    PDF Downloaded48    
    Comments [Add]    

Recommend this journal