Electrocardiographic changes during cholangiopancreatography: DISCUSSION (Part 3)

BuscopanBuscopan increases heart rate because it has anticholinergic properties. Premedication with anticholinergic drugs tends to shift the balance of the autonomous nervous system towards sympathetic dominance which increases the cardiac work and heart rate. It has been suggested that patients with cardiac disease, anticholinergic drugs may increase the risk of cardiac complications during endoscopic examination and they should be avoided in shuch patients. These authors state that withholding anticholinergic premedication does not seriously affect the endoscopic examination. To confirm whether psychological stress could alter the cardiac vulnerability, the investigators compared the heart rate in patients who had never undergone endoscopy with those who had. They found that the heart rate increased during endoscopy, but did not increased significantly in those who had previous endoscopy, indicating that psychological factors play an important role in the electrocardiographic changes during endoscopy.

Neural inhibition of the diaphragm by viscerosomatic reflexes due to esophageal and gastric distention has been thought to be another possibility. Additionally an increase in vagal activity as a result of gastrointestinal manipulation may induce vasospasm and reduce coronary blood flow with consequent brochospasm, ventilation-perfusion mismatch, hypoxia and blood desaturation. These effects may be potentiated by benzodiazepines given as premedication sedatives. However endoscopy without sedation also causes significant reduction in oxygen saturation after introduction of the endoscope.

The present study is the only one in the literature to monitor elderly patients, greater than 70 years of age during ERCP. Elderly patients might be more vulnerable to hypoxemia. Hypoxaemia is a documented consequence of endoscopic manipulations and has been attributed to hypoventilation secondary to sedative medication, partial obstruction by the endoscopy and possible ventilation-perfusion mismatch caused by autonomic disturbance. In all our patients the oxygen saturation decreased during the procedure and this was correlated with ST segment deviation and arrhythmias. Twenty nine of our patients (96%) developed also sinus tachycardia with heart rate above 100 beats/min. However, while all of our patients developed hypoxaemia and 29 sinus tachycardia, only 16 patients developed ST segment changes. Best quality drugs available at best online pharmacy at prices that you are going to enjoy every time: get your levitra professional sale cialis professional with no problems and no prescription of any kind any time you need some treatment that works 100%.

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