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Risk factors for intraoperative bradycardia during ear, nose, throat and maxillofacial surgery

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Abstract

Intraoperative bradycardia (IOB) is one of the most common cardiac arrhythmias observed in clinical anaesthetic practice. Controlled hypotension, as a strategy of lowering patient’s blood pressure during anesthesia has been practiced for decades in head and neck surgery. The aim of our study was to determine the incidence and the risk factors for intraoperative bradycardia in maxillofacial, ear, nose and throat surgery, as well as to determine whether controlled hypotension affects the occurrence of IOB. The retrospective study included 2304 patients who underwent maxillofacial, ear, nose or throat surgery. We studied the influence of: sex, age, comorbidity, type of surgery, duration of anesthesia and controlled hypotension on the occurrence of IOB. IOB was registered in 473 patients (20.5%). Patients with controlled hypotension had IOB significantly more often than patients without controlled hypotension (33.9 vs 15.1%) (p = 0.000). The significant predictors of IOB were: age (OR = 1.158; 95% CI = 1.068–1.256; p = 0.000), sex (OR = 0.786; 95% CI = 0.623–0.993; p = 0.043), ischemic heart disease (OR = 2.016; 95% CI = 1.182–3.441; p = 0.010); ear surgery (OR = 1.593; 95% CI = 1.232–2.060; p = 0.000), anesthesia duration, (OR = 1.006; 95% CI = 1.004–1.007; p = 0.000) and controlled hypotension (OR = 2.204; 95% CI = 1.761–2.758; p = 0.000). IOB is common in maxillofacial, ear, nose and throat surgery, particularly in male, older age and patients with ishemic heart disease. The ear surgery, longer anesthesia duration and controlled hypotension raise the risk for occurrence of IOB.

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Authors and Affiliations

  1. Center for Anesthesiology and Resuscitation, Clinical Center of Serbia, Belgrade, Serbia

    Tjaša Ivošević, Marina Stojanović, Ksenija Stevanović & Nevena Kalezić

  2. Department of Medical Statistics and Informatics, Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia

    Biljana Miličić

  3. Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia

    Milovan Dimitrijević

  4. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

    Milovan Dimitrijević, Branislava Ivanović, Marina Stojanović & Nevena Kalezić

  5. Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia

    Branislava Ivanović

  6. Faculty of Medicine, University of Priština, Priština, Serbia

    Aleksandar Pavlović

  7. Department of Anesthesia, Resuscitation and Pain therapy, Clinical Hospital Center Zemun, Belgrade, Serbia

    Mirko Lakićević

Authors
  1. Tjaša Ivošević
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  2. Biljana Miličić
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  3. Milovan Dimitrijević
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  4. Branislava Ivanović
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  5. Aleksandar Pavlović
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  6. Marina Stojanović
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  7. Mirko Lakićević
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  8. Ksenija Stevanović
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  9. Nevena Kalezić
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Correspondence to Tjaša Ivošević.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of The Ethics committee of The School of Medicine, University of Belgrade, and with the 1964 Helsinki declaration and its later amendements or comparable ethical standards.

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Ivošević, T., Miličić, B., Dimitrijević, M. et al. Risk factors for intraoperative bradycardia during ear, nose, throat and maxillofacial surgery. Eur Arch Otorhinolaryngol 275, 579–586 (2018). https://doi.org/10.1007/s00405-017-4837-8

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  • DOI: https://doi.org/10.1007/s00405-017-4837-8

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