Yonsei Med J.  2007 Jun;48(3):474-479. 10.3349/ymj.2007.48.3.474.

Risk Factors for an Intraoperative Arrhythmia during Esophagectomy

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Samsung Medical Center, 50 Ilwon-dong, Kangnam-gu, Seoul 135-710, Korea. jakim@smc.samsung.co.kr

Abstract

PURPOSE
Arrhythmias after an esophagectomy (most commonly atrial fibrillation) are a significant contributing factor to patient morbidity. However, the significance of an intraoperative arrhythmia is not completely understood. The aim of this retrospective study was to determine the occurrence and risk factors for developing intraoperative arrhythmias in patients undergoing an esophagectomy. MATERIALS AND METHODS: We reviewed the records of 427 patients who underwent a transthoracic esophagectomy between 2001 and 2005. Variables such as age, sex, hypertension, diabetes, cardiac disease, preoperative pulmonary function test (PFT) results, cancer level, combined radiochemotherapy, intrathoracic cavity adhesions and anastomosis site, hemoglobin, central venous pressure (CVP), fluid balance, serum potassium level, dose of vasopressors, temperature, and combined general and epidural anesthesia were analyzed as risk factors for the occurrence of an arrhythmia. We defined this arrhythmia as one not originating from the sinus node. RESULTES: The incidence of intraoperative arrhythmia in this subset of patients was 17.1%, with a 37.2% reoccurrence rate during the first three postoperative days. Univariate and multivariate analysis revealed the presence of heart disease, poor PFTs, cervical anastomosis, elevated CVP, and higher ephedrine doses to be independent predictors of the development of an intraoperative arrhythmia. CONCLUSION: The incidence of intraoperative arrhythmia during esophagectomy was 17.1% with a 37.2% of reoccurrence rate.

Keyword

Arrhythmia; esophagectomy

MeSH Terms

Aged
Arrhythmias, Cardiac/*etiology/pathology
Esophagectomy/*adverse effects/statistics & numerical data
Female
Humans
Intraoperative Complications/*etiology/pathology
Male
Middle Aged
Risk Factors

Reference

1. Viklund P, Lindblad M, Lu M, Ye W, Johansson J, Lagergren J. Risk factors for complications after esophageal cancer resection: a prospective population-based study in Sweden. Ann Surg. 2006. 243:204–211.
2. Amar D. Cardiopulmonary complications of esophageal surgery. Chest Surg Clin N Am. 1997. 7:449–456.
3. Atkins BZ, Shah AS, Hutcheson KA, Mangum JH, Pappas TN, Harpole DH Jr, et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg. 2004. 78:1170–1176.
Article
4. Force S. The "innocent bystander" complications following esophagectomy: atrial fibrillation, recurrent laryngeal nerve injury, chylothorax, and pulmonary complications. Semin Thorac Cardiovasc Surg. 2004. 16:117–123.
Article
5. Ma JY, Wang Y, Zhao YF, Wu Z, Liu LX, Kou YL, et al. Atrial fibrillation after surgery for esophageal carcinoma: clinical and prognostic significance. World J Gastroenterol. 2006. 12:449–452.
Article
6. Stippel DL, Taylan C, Schroder W, Beckurts KT, Holscher AH. Supraventricular tachyarrhythmia as early indicator of a complicated course after esophagectomy. Dis Esophagus. 2005. 18:267–273.
Article
7. Neal JM, Wilcox RT, Allen HW, Low DE. Near-total esophagectomy: the influence of standardized multimodal management and intraoperative fluid restriction. Reg Anesth Pain Med. 2003. 28:328–334.
Article
8. Amar D, Burt ME, Bains MS, Leung DH. Symptomatic tachydysrhythmias after esophagectomy: incidence and outcome measures. Ann Thorac Surg. 1996. 61:1506–1509.
Article
9. Ritchie AJ, Whiteside M, Tolan M, McGuigan JA. Cardiac dysrhythmia in total thoracic oesophagectomy. A prospective study. Eur J Cardiothorac Surg. 1993. 7:420–422.
Article
10. Murthy SC, Law S, Whooley BP, Alexandrou A, Chu KM, Wong J. Atrial fibrillation after esophagectomy is a marker for postoperative morbidity and mortality. J Thorac Cardiovasc Surg. 2003. 126:1162–1167.
Article
11. Vaporciyan AA, Correa AM, Rice DC, Roth JA, Smythe WR, Swisher SG, et al. Risk factors associated with atrial fibrillation after noncardiac thoracic surgery: analysis of 2588 patients. J Thorac Cardiovasc Surg. 2004. 127:779–786.
Article
12. Magder S. Central venous pressure: A useful but not so simple measurement. Crit Care Med. 2006. 34:2224–2227.
Article
13. Magder S. How to use central venous pressure measurements. Curr Opin Crit Care. 2005. 11:264–270.
Article
14. Kim SH, Lee KS, Shim YM, Kim K, Yang PS, Kim TS. Esophageal resection: indications, techniques, and radiologic assessment. Radiographics. 2001. 21:119–140.
Article
15. Groban L, Dolinski SY, Zvara DA, Oaks T. Thoracic epidural analgesia: its role in postthoracotomy atrial arrhythmias. J Cardiothorac Vasc Anesth. 2000. 14:662–665.
Article
16. Oka T, Ozawa Y, Ohkubo Y. Thoracic epidural bupivacaine attenuates supraventricular tachyarrhythmias after pulmonary resection. Anesth Analg. 2001. 93:253–259.
Article
17. Ahn HJ, Sim WS, Shim YM, Kim JA. Thoracic epidural anesthesia does not improve the incidence of arrhythmias after transthoracic esophagectomy. Eur J Cardiothorac Surg. 2005. 28:19–21.
Article
Full Text Links
  • YMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr