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[Preoperative ECG in routine preoperative assessment of children]
J von Walter1, K Kroiss, P Höpner
1Kinderkardiologie, Kinderklinik und Poliklinik, Technischen Universität München.
Insights
Routine preoperative electrocardiograms (ECGs) are not necessary for children undergoing anesthesia and surgery. A study found no complications in children who had ECGs, suggesting they are only needed if heart conditions are suspected.
Area of Science:
- Pediatric Anesthesiology
- Cardiology
- Medical Diagnostics
Background:
- Preoperative assessment is crucial for pediatric anesthesia.
- Electrocardiograms (ECGs) are sometimes used to evaluate cardiac risk.
- The necessity of routine preoperative ECGs in children remains debated.
Purpose of the Study:
- To determine if routine preoperative ECGs are necessary for pediatric anesthesia and surgery.
- To assess the diagnostic value of preoperative ECGs in identifying potential complications.
Main Methods:
- Retrospective analysis of 3030 pediatric anesthesia records from 1990.
- Comparison of anesthetic complications with preoperative ECG findings.
- Survey of 51 German pediatric hospitals regarding ECG practices.
Main Results:
- Out of 3030 anesthesias, 93 complications occurred; 67 were non-cardiac.
- Only 4 cardiac complications required therapy; none occurred in 180 children with preoperative ECGs.
- Most hospitals reserve preoperative ECGs for cases with suspected heart disease.
Conclusions:
- Routine preoperative ECGs are not indicated for all children.
- ECGs are recommended only when clinical symptoms suggest heart disease.
- Selective ECG use optimizes resource allocation and avoids unnecessary procedures.
Objective:
The aim of this study is to examine whether a routine preoperative ECG is necessary in children to assess the risks in anaesthesia and surgery.
Methods:
We examined the records of 3030 children anaesthetized in our hospital in 1990 and compared records of complications with preoperative ECGs. We also evaluated questionnaires on this subject which we had sent to 51 large pediatric hospitals in Germany in 1991.
Results:
During 3030 anaesthetic procedures there were 93 complications, 67 of which were not of cardiac origin. Of the 26 cardiac complications only 4 needed therapy (AV-Block 2 degrees, fall in blood pressure). Preoperative ECGs were recorded in 180 cases: 152 were normal, 8 showed harmless deviations from normal and 16 were recorded because of known cardiac defects. None of the 180 children developed complications during anaesthesia. Our questionnaire was returned completed carefully by 36 of the 51 hospitals. In most hospitals a preoperative ECG is only recorded when heart disease is known or suspected.
Conclusion:
Routine preoperative ECGs are unnecessary in children unless there are clinical symptoms of heart diseases or heart disease is suspected.