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Quantification of cardiac stress during EGD without sedation
Wataru Adachi1, Kazuyuki Yazawa, Mafumi Owa
1Second Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
Background:
Although the complication rate of endoscopy is low, EGD may induce cardiac stress. The aim of this study was to quantify cardiac stress during EGD.
Methods:
Heart rate, blood pressure, cardiac output, and peripheral oxygen saturation were measured during endoscopy without sedation in 7 volunteers. Cardiac output was measured with an automated echocardiographic technique. Cardiac index, left ventricular work index, and rate-pressure product were calculated. Serum catecholamine concentrations were measured before and after the examination.
Results:
Heart rate increased significantly when the endoscope was located in the esophagus compared with the rate before insertion (p < 0.05). No significant changes in cardiac index and left ventricular work index were observed during endoscopy. Rate-pressure product increased significantly at the point of esophageal observation compared with that before insertion (p < 0.05). The rate-pressure product was maximally increased during esophageal observation at 66% over baseline (95% CI [45%, 86%]). Serum concentration of norepinephrine rose significantly after the examination (p < 0.05).
Conclusions:
Cardiac output did not increase during EGD without sedation in healthy male volunteers. Cardiac stress increased during EGD as indicated by a 66% increase in rate-pressure product. The cardiac stress was approximately equal to that observed in 3.3 to 5 metabolic equivalents of treadmill exercises.