Exaggerated plethysmography waveforms associated with premature ventricular contractions

This case report describes a 58-year-old man with severe chronic obstructive pulmonary disease and significant cardiac history who underwent laparoscopic appendectomy. During surgery, plethysmography waves with amplitudes exceeding the upper graphical display limit were observed following premature ventricular contractions. These exaggerated waveforms likely resulted from increased stroke volume due to the compensatory pause following each premature ventricular contraction. This phenomenon, though rarely documented, may offer clinical value in understanding peripheral haemodynamic responses to arrhythmia. While similar to the Brockenbrough-Braunwald-Morrow sign described in invasive cardiac studies, this case uniquely demonstrates such findings through non-invasive plethysmography. This observation prompts further exploration into waveform interpretation beyond conventional assumptions in peri-operative monitoring.