Perioperative QT and QTc Changes in Laparoscopic and Open Hysterectomy

This was a prospective, single-center observational cohort study including 48 adult female patients with American Society of Anesthesiologists physical status I-II undergoing elective hysterectomy under general anesthesia. Patients were classified into two cohorts according to the surgical approach: laparoscopic hysterectomy (Group L) and open abdominal hysterectomy (Group A). The surgical technique was selected independently by the treating gynecologic surgeon based on clinical considerations and was not determined by the study investigators.

A standardized general anesthesia protocol was applied to both groups. Continuous electrocardiographic monitoring was performed, and QT intervals were automatically measured from lead II using the perioperative monitoring system. Corrected QT intervals were calculated automatically using Bazett's formula.

QT and QTc intervals were evaluated at predefined perioperative time points: before anesthesia induction (T0), after anesthesia induction (T1), immediately before tracheal intubation (T2), immediately after tracheal intubation (T3), before the relevant surgical stimulus (T4), immediately after the surgical stimulus (T5), at the end of surgery (T6), and immediately after tracheal extubation (T7). In addition, the difference between the maximum and minimum perioperative QT and QTc values obtained from measurements recorded at five-minute intervals was evaluated. Hemodynamic and respiratory adverse events were also recorded.

Inclusion criteria

• Adult patients scheduled for elective laparoscopic or open abdominal hysterectomy under general anesthesia
• American Society of Anesthesiologists physical status I-II
• Written informed consent for participation

Exclusion criteria

• Unstable angina
• Severe heart failure
• Preoperative QTc interval >460 ms
• Use of medications known to affect the QTc interval
• Family history of long QT syndrome
• Cardiac arrhythmia or conduction abnormality on electrocardiography
• Permanent pacemaker
• Electrolyte abnormalities
• Chronic obstructive pulmonary disease
• Hepatic disease
• Renal disease
• Anemia
• Neuromuscular disease
• Refusal to participate