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Inoue K, Tajiri K, Xu D, Murakoshi N, Ieda M. Risk Factors and In-Hospital Outcomes of Perioperative Atrial Fibrillation for Patients with Cancer: A Meta-Analysis. Ann Surg Oncol 2023; 30:711-721. [PMID: 36273057 DOI: 10.1245/s10434-022-12690-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/06/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Perioperative atrial fibrillation is a common postoperative complication. Adverse consequences associated with POAF include hemodynamic instability, increased risk of stroke, extended hospital stays, and increased mortality. METHODS To determine the risk factors for POAF and to investigate the outcomes of POAF for patients with cancer, a systematic search of the PubMed and Cochrane Library databases was conducted from inception of the study to 1 September 2021. The inclusion criteria specified studies reporting the prevalence of POAF among patients with cancer. The study excluded articles not written in English, review articles, case reports, letters, commentaries, systematic reviews, meta-analyses, and conference abstracts. RESULTS The search identified 49 studies with 201,081 patients, and the pooled prevalence of POAF was 13.5% (95% confidence interval [CI], 11.6-15.7%). Meta-analyses showed that the incidence of POAF among patients with cancer was associated with age (mean difference [MD], 4.31; 95%CI, 3.16-5.47), male sex (odds ratio [OR], 1.39; 95% CI, 1.19-1.62), chronic obstructive pulmonary disease (OR, 2.47; 95% CI, 1.71-3.56), hypertension (OR, 1.47; 95% CI, 1.23-1.75), intraoperative blood transfusion (OR, 4.58; 95% CI, 2.31-9.10), and open surgery (OR, 1.51; 95% CI, 1.26-1.81). Patients with POAF had significantly higher in-hospital mortality (OR, 4.25; 95% CI, 2.79-6.45), longer hospital stays (MD, 3.07; 95% CI, 1.63-4.51), and higher incidences of pneumonia (OR, 3.32; 95% CI, 2.85-3.86), stroke (OR, 6.57; 95% CI, 1.56-26.00), and myocardial infarction (OR, 3.00; 95% CI, 1.45-6.20) than those without POAF. CONCLUSIONS For patients with cancer, POAF is associated with an increased burden of comorbidities and worse outcomes.
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Affiliation(s)
- Keiko Inoue
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazuko Tajiri
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. .,Department of Cardiology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - DongZhu Xu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Nobuyuki Murakoshi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Song EY, Venkat P, Fradley M, Frakes JM, Klocksieben F, Fontaine J, Mehta R, Saeed S, Hoffe SE, Pimiento JM. Clinical factors associated with the development of postoperative atrial fibrillation in esophageal cancer patients receiving multimodality therapy before surgery. J Gastrointest Oncol 2020; 11:68-75. [PMID: 32175107 DOI: 10.21037/jgo.2019.12.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background The incidence of esophageal cancer (EC) is increasing in the USA. Neoadjuvant therapy for locally advanced cancers followed by surgical resection is the standard of care. The most common post-esophagectomy cardiac complication is atrial fibrillation (AF). New-onset postoperative AF can require a prolonged hospital stay and may confer an overall poorer prognosis. In this study, we seek to identify clinical factors associated with postoperative AF. Methods Query of an IRB approved database of 1,039 esophagectomies at our institution revealed 677 patients with EC from 1999 to 2017 who underwent esophagectomy after neoadjuvant treatment. Age, treatment location (primary vs. other), gender, neoadjuvant radiation type [2D vs. 3D vs. intensity modulated radiation therapy (IMRT)], radiation dose, surgery type (transthoracic vs. transhiatal vs. three field), smoking history, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), operative time, blood transfusions, fluid management, and length of stay (LOS) were analyzed in relationship to the development of AF. Statistical analysis was performed with SPSS 24. Results The mean age of the entire cohort was 64.3 (range, 28-86 years), with a Caucasian and male preponderance (White: 94.5%; male: 83.6%). Of the 677 patients, 14.9% (n=101) developed postoperative AF. Increasing age (P<0.001), increased radiation dose (P=0.034), operative time (P=0.001), and blood transfusions (P=0.027) were associated with AF. LOS was longer in patients with AF than those without AF (10.5 vs. 10.0 days, P=0.001). On multivariate analysis, increasing age (95% CI: 1.023-1.080, P<0.001) and radiation dose (95% CI: 1.000-1.001, P=0.034) remained significant. None of the other parameters assessed were associated with the development of AF. Conclusions Increasing age and radiation dose were associated with the development of postoperative AF in this cohort. This study suggests that older patients or patients receiving higher radiation dose should be monitored more closely in the postoperative setting and potentially referred earlier preoperatively for cardio-oncology assessment. Future study is required to determine if modification of current radiation techniques and cardiac dose constraints in this patient population may be warranted.
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Affiliation(s)
- Ethan Y Song
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Puja Venkat
- Department of Radiation Oncology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Michael Fradley
- Department of Cardio-Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jessica M Frakes
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Farina Klocksieben
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jacques Fontaine
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Rutika Mehta
- Department of GI Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Sabrina Saeed
- Department of GI Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Sarah E Hoffe
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jose M Pimiento
- Department of GI Oncology, Moffitt Cancer Center, Tampa, FL, USA
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Tisdale JE, Jaynes HA, Watson MR, Corya AL, Shen C, Kesler KA. Amiodarone for prevention of atrial fibrillation following esophagectomy. J Thorac Cardiovasc Surg 2019; 158:301-310.e1. [PMID: 30853230 DOI: 10.1016/j.jtcvs.2019.01.095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/30/2018] [Accepted: 01/19/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Atrial fibrillation (AF) is a common complication after esophagectomy and is associated with symptoms, hemodynamic instability, prolonged hospital stay, and an increased incidence of mortality. Our objective was to determine the efficacy and safety of intravenous amiodarone for prophylaxis of postesophagectomy AF. METHODS In this retrospective cohort study, 309 patients who underwent esophagectomy formed the initial cohort. Following propensity score-matching, 110 patients who received prophylactic amiodarone 43.75 mg/hour via continuous intravenous infusion over 96 hours (total dose, 4200 mg) were matched to a control group of patients who did not undergo amiodarone prophylaxis (n = 110). The propensity score was obtained using a multivariate logistic regression model with amiodarone as the variable and the following covariates: age, sex, surgical approach, history of neoadjuvant chemotherapy and/or radiation, chronic obstructive pulmonary disease, heart failure, cardiovascular disease, alcohol use (>7 drinks/week), preadmission β-blockers discontinued during hospitalization, preoperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, preoperative use of corticosteroids, postoperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, postoperative use of corticosteroids, postoperative use of statins, and preoperative Charlson comorbidity index. RESULTS The incidence of AF requiring treatment due to rapid ventricular rate and symptoms was lower in the amiodarone group (17 out of 110 [15.5%] vs 32 out of 110 [29.1%]; odds ratio, 0.45; 95% confidence interval, 0.23-0.86; P = .015). There were no significant differences between the groups in median postoperative length of hospital stay, incidence of pulmonary complications, or mortality. The incidences of hypotension requiring treatment (42.7% vs 21.8%; P = .001), bradycardia (8.2% vs 0.0%; P = .002), and corrected QT interval prolongation (10.9% vs 0.0%; P ≤ .0001) were significantly higher in the amiodarone group. CONCLUSIONS Prophylactic intravenous amiodarone is associated with a reduction in the incidence of AF following esophagectomy, but is not associated with shorter postoperative length of hospital stay. Intravenous amiodarone for prophylaxis of postesophagectomy AF is associated with hypotension, bradycardia, and corrected QT interval prolongation.
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Affiliation(s)
- James E Tisdale
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, Ind; Department of Medicine, School of Medicine, Indiana University, Indianapolis, Ind.
| | - Heather A Jaynes
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, Ind
| | - Matthew R Watson
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, Ind
| | - Andi L Corya
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, Ind
| | - Changyu Shen
- The Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Kenneth A Kesler
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, Ind
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Colwell EM, Encarnacion CO, Rein LE, Szabo A, Haasler G, Gasparri M, Tisol W, Johnstone D. Atrial fibrillation after transhiatal esophagectomy with transcervical endoscopic esophageal mobilization: one institution's experience. J Cardiothorac Surg 2018; 13:73. [PMID: 29921284 PMCID: PMC6007001 DOI: 10.1186/s13019-018-0746-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/31/2018] [Indexed: 11/10/2022] Open
Abstract
Background There have been numerous studies regarding atrial fibrillation (AF) associated with cardiac and pulmonary surgery; however, studies looking at esophagectomy and atrial fibrillation are sparse. The goal of this study was to review our institution’s atrial fibrillation rate following esophagectomy in order to better define the incidence and predisposing factors in this patient population. Methods A retrospective chart review of all patients undergoing esophagectomy with transcervical endoscopic mobilization of the esophagus (TEEM) at the Medical College of Wisconsin and Affiliated Hospitals from July 2009 through December 2012. Results Seventy-one patients underwent TEEM esophagectomy during the study period. Of those, 23 (32.4%) patients developed new atrial fibrillation postoperatively. ICU (Intensive Care Unit) length of stay was 7.1 days for those that did not receive amiodarone, compared to 5.3 days for those that did receive amiodarone (p < 0.025). Those that went into AF spent on average 9.3 days in the ICU compared to 4.7 days for their counterparts that did not go into AF (p < 0.006). Total length of stay was not statistically different between populations [15.1 +/− 11.3 days compared to 13.5 +/− 9.4 days for those who did not go into AF (p < 0.281)]. Receiving preoperative amiodarone was found to reduce the overall incidence of AF. There was a trend towards decreased risk of going into AF in those who received preoperative amiodarone with an adjusted hazard ratio of 0.555 (p = 0.057). Conclusion Similar to data reported in previous literature, postoperative atrial fibrillation was found to increase ICU length of stay as well as overall length of hospital stay. Preoperative amiodarone administration displayed a trend toward decreasing the rates of atrial fibrillation in patients undergoing TEEM.
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Affiliation(s)
- Elizabeth M Colwell
- Cardiothoracic Surgery, Stanford University, 300 Pasteur Dr. Falk Cardiovascular Research Bldg, Stanford, CA, 94305-5407, USA.
| | - Carlos O Encarnacion
- University of Maryland, Division of Cardiac Surgery, 110 S. Paca St. 7th floor, Baltimore, MD, 21201, USA
| | - Lisa E Rein
- Medical College of Wisconsin, 8701 Watertown Plank Road, PO Box 26509, Milwaukee, WI, 53226, USA
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, 8701 W. Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - George Haasler
- Division of Cardiothoracic Surgery, HUB for Collaborative Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Mario Gasparri
- Division of Cardiovascular and Thoracic Surgery, SSM Heath - St. Mary's Madison, Madison, WI, 53715, USA
| | - William Tisol
- Aurora Medical Group CVTS, 2901 W Kinnickinnic River Pkwy Suite 501, Milwaukee, WI, 53125, USA
| | - David Johnstone
- Division of Cardiothoracic Surgery, HUB for Collaborative Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
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Huang HT, Wang F, Shen L, Xia CQ, Lu CX, Zhong CJ. Comparison of thoracolaparoscopic esophagectomy with cervical anastomosis with McKeown esophagectomy for middle esophageal cancer. World J Surg Oncol 2015; 13:310. [PMID: 26542373 PMCID: PMC4635614 DOI: 10.1186/s12957-015-0727-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 11/02/2015] [Indexed: 01/01/2023] Open
Abstract
Background In China, the middle esophageal squamous cell cancer is the most common tumor type, and Mckeown esophagectomy (ME) is preferably adopted by thoracic surgeon. But, the surgical trauma of ME is great. Thoracolaparoscopic esophagectomy (TE) was developed to decrease the operative stress; however, the safety and efficacy were not defined. In this study, clinical outcomes were compared between patients who received ME and TE. Methods The data of 113 patients who suffered from middle-thoracic esophageal cancer during the same period were collected. Sixty-two patients received ME (ME group), and 51 patients received TE (TE group). Patients’ demographics and short-term clinicopathologic outcomes were comparable between the two groups. Survival rate was estimated using the Kaplan–Meier method, and comparisons between groups were performed with log–rank test. Results Patients in TE group had lower body mass index (BMI). Preoperative tumor stage in TE group was much earlier. Both overall and thoracic operation time were longer in TE group. The blood loss during operation and postoperative day (POD) 1 was less in TE group, which contributed to the less blood transfusion. In TE group, postoperative incidence of pulmonary complications and atrial fibrillation (p = 0.035 and p = 0.033) was lower; the inflammatory response and incision pain were significantly alleviated; the ICU and in-hospital stay was shorter as well because of less surgical trauma. No statistically significant difference was found between two groups in terms of overall survival or disease-free survival. Conclusions The efficacy and safety of TE were supported by the selected patients in this cohort study. Although it is lack of randomness in this research, some advantages of TE were gratifying such as lower postoperative complications and similar survival with ME. A multicenter prospective randomized study is now required.
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Affiliation(s)
- Hai-Tao Huang
- Department of Thoracic and Cardiovascular Surgery, Nantong First People's Hospital, the Second Affiliated Hospital of Nantong University, No.6 North Hai'er Xiang Road, Nantong, 226001, People's Republic of China.
| | - Fei Wang
- Department of Thoracic and Cardiovascular Surgery, Nantong First People's Hospital, the Second Affiliated Hospital of Nantong University, No.6 North Hai'er Xiang Road, Nantong, 226001, People's Republic of China.
| | - Liang Shen
- Department of Thoracic and Cardiovascular Surgery, Nantong First People's Hospital, the Second Affiliated Hospital of Nantong University, No.6 North Hai'er Xiang Road, Nantong, 226001, People's Republic of China.
| | - Chun-Qiu Xia
- Department of Thoracic and Cardiovascular Surgery, Nantong First People's Hospital, the Second Affiliated Hospital of Nantong University, No.6 North Hai'er Xiang Road, Nantong, 226001, People's Republic of China.
| | - Chen-Xi Lu
- Department of Thoracic and Cardiovascular Surgery, Nantong First People's Hospital, the Second Affiliated Hospital of Nantong University, No.6 North Hai'er Xiang Road, Nantong, 226001, People's Republic of China.
| | - Chong-Jun Zhong
- Department of Thoracic and Cardiovascular Surgery, Nantong First People's Hospital, the Second Affiliated Hospital of Nantong University, No.6 North Hai'er Xiang Road, Nantong, 226001, People's Republic of China.
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Garg R, Bhatnagar A, Bhatnagar S, Mishra S. Incidental finding of organized thrombus in right inferior pulmonary vein extending in left atrium in the patient scheduled for esophagectomy: What should an anesthesiologist look for? J Anaesthesiol Clin Pharmacol 2014; 30:301-2. [PMID: 24803790 PMCID: PMC4009672 DOI: 10.4103/0970-9185.130133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Rakesh Garg
- Assistant Professor, Department of Anaesthesiology, Pain and Palliative Care, Dr. BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
- Address for correspondence: Dr. Rakesh Garg, 35, DDA Flats, East Punjabi Bagh, New Delhi - 110 026, India. E-mail:
| | - Alka Bhatnagar
- Senior Resident, Department of Anaesthesiology, Pain and Palliative Care, Dr. BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Additional Professor and Head, Department of Anaesthesiology, Pain and Palliative Care, Dr. BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Additional Professor, Department of Anaesthesiology, Pain and Palliative Care, Dr. BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
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Landiolol hydrochloride for early postoperative tachycardia after transthoracic esophagectomy. Surg Today 2013; 44:848-54. [DOI: 10.1007/s00595-013-0615-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 03/08/2013] [Indexed: 11/26/2022]
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Johansson T, Fritsch G, Flamm M, Hansbauer B, Bachofner N, Mann E, Bock M, Sönnichsen AC. Effectiveness of non-cardiac preoperative testing in non-cardiac elective surgery: a systematic review. Br J Anaesth 2013; 110:926-39. [PMID: 23578861 DOI: 10.1093/bja/aet071] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Elective surgery is usually preceded by preoperative diagnostics to minimize risk. The results are assumed to elicit preventive measures or even cancellation of surgery. Moreover, physicians perform preoperative tests as a baseline to detect subsequent changes. This systematic review aims to explore whether preoperative testing leads to changes in management or reduces perioperative mortality or morbidity in unselected patients undergoing elective, non-cardiac surgery. We systematically searched all relevant databases from January 2001 to February 2011 for studies investigating the relationship between preoperative diagnostics and perioperative outcome. Our methodology was based on the manual of the Ludwig Boltzmann Institute for Health Technology Assessment, the Scottish Intercollegiate Guidelines Network (SIGN) handbook, and the PRISMA statement for reporting systematic reviews. One hundred and one of the 25 281 publications retrieved met our inclusion criteria. Three test grid studies used a randomized controlled design and 98 studies used an observational design. The test grid studies show that in cataract surgery and ambulatory surgery, there are no significant differences between patients with indicated preoperative testing and no testing regarding perioperative outcome. The observational studies do not provide valid evidence that preoperative testing is beneficial in healthy adults undergoing non-cardiac surgery. There is no evidence derived from high-quality studies that supports routine preoperative testing in healthy adults undergoing non-cardiac surgery. Testing according to pathological findings in a patient's medical history or physical examination seems justified, although the evidence is scarce. High-quality studies, especially large randomized controlled trials, are needed to explore the effectiveness of indicated preoperative testing.
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Affiliation(s)
- T Johansson
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria.
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Paroxysmal atrial fibrillation and epidural anesthesia. J Clin Anesth 2013; 25:74-5. [DOI: 10.1016/j.jclinane.2012.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 06/23/2012] [Accepted: 06/25/2012] [Indexed: 11/21/2022]
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Rogers WK, Schroeder KM. Perioperative atrial fibrillation and epidural anesthesia: case report and review of the literature. J Clin Anesth 2012; 24:329-33. [PMID: 22608590 DOI: 10.1016/j.jclinane.2011.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 10/05/2011] [Accepted: 10/12/2011] [Indexed: 11/16/2022]
Abstract
A case of new-onset atrial fibrillation subsequent to activation of neuraxial anesthesia is presented. The development of atrial fibrillation was temporally related to placement and dosing of an epidural catheter, and may have been triggered by a vagal response to dosing of the anesthetic or the resulting treatment with fluid and an adrenergic agent. The literature on the acute preoperative management of atrial fibrillation and the implications of atrial fibrillation for the patient undergoing regional anesthesia are reviewed.
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Affiliation(s)
- William Kirke Rogers
- Department of Anesthesiology, University of Wisconsin Hospital and Clinics, Madison, WI 53792, USA.
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Feeney C, Hussey J, Carey M, Reynolds JV. Assessment of physical fitness for esophageal surgery, and targeting interventions to optimize outcomes. Dis Esophagus 2010; 23:529-39. [PMID: 20459443 DOI: 10.1111/j.1442-2050.2010.01058.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review examines how higher levels of physiological reserve and fitness can help the patient endure the demands of esophageal surgery. Lung function, body composition, cardiac function, inflammatory mediators and exercise performance are all determinants of fitness. Physical fitness, both as an independent risk factor and through its effect on other risk factors, has been found to be significantly associated with the risk of developing postoperative pulmonary complications (PPCs) in patients following esophagectomy. Respiratory dysfunction preoperatively poses the dominant risk of developing complications, and PPCs are the most common causes of morbidity and mortality. The incidence of PPCs is between 15 and 40% with an associated 4.5-fold increase in operative mortality leading to approximately 45% of all deaths post-esophagectomy. Cardiac complications are the other principal postoperative complications, and pulmonary and cardiac complications are reported to account for up to 70% of postoperative deaths after esophagectomy. Risk reduction in patients planned for surgery is key in attaining optimal outcomes. The goal of this review was to discuss the risk factors associated with the development of postoperative pulmonary complications and how these may be modified prior to surgery with a specific focus on the pulmonary complications associated with esophageal resection. There are few studies that have examined the effect of modifying physical fitness pre-esophageal surgery. The data to date would indicate a need to develop targeted interventions preoperatively to increase physical function with the aim of decreasing postoperative complications.
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Affiliation(s)
- C Feeney
- Department of Physiotherapy, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
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A randomized, controlled study of amiodarone for prevention of atrial fibrillation after transthoracic esophagectomy. J Thorac Cardiovasc Surg 2010; 140:45-51. [DOI: 10.1016/j.jtcvs.2010.01.026] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 12/24/2009] [Accepted: 01/18/2010] [Indexed: 11/24/2022]
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Current World Literature. Curr Opin Anaesthesiol 2008; 21:85-8. [DOI: 10.1097/aco.0b013e3282f5415f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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