Original articleGeneral thoracicIncidence and Types of Arrhythmias After Mediastinal Manipulation During Transhiatal Esophagectomy
Section snippets
Patient Population
This prospective study was carried out in 20 consecutive American Society of Anesthesiologists I-II patients, aged 40 to 60 years, of both sexes undergoing THE for carcinoma esophagus for midesophageal tumors. Institutional Review Board approved the study dated June 18, 2001 and individual informed consent from all the patients was duly obtained.
Patients excluded from the study were those with any cardiac dysfunctions, severe pulmonary obstruction or restriction, and patients with electrolyte
Patient Characteristics
The demographic data and various hemodynamic and electrolyte variables are given in Table 1. Total duration of the surgery ranged from 3 to 5 hours. The mean duration of mediastinal manipulation was 7.90 ± 3.49 minutes (range, 4 to 15 minutes).
Arrhythmias
In the premanipulation period, only 2 (10%) patients had arrhythmias while 13 (65%) had arrhythmias during the manipulation period (p < 0.01) as shown in Table 2. In almost all the patients, the arrhythmias were transient and occurred as singlet or
Comment
The transhiatal esophagectomy is based on an upper abdominal approach through a midline supraumbilical incision with blind manual manipulation of the esophagus in the mediastinum. During the manipulation, the surgeon’s hand, dissecting bluntly around the esophagus inevitably compresses the atria and distorts the heart, causing profound arterial hypotension and arrhythmias [2]. Also, the dissection can induce marked vagal stimulation resulting in bradyarrhythmia, ventricular escape beats and,
References (20)
- et al.
Thoracoscopic esophageal mobilization for pharyngolaryngoesophagectomy
Ann Thorac Surg
(2000) Transhiatal esophagectomy for benign disease
J Thorac Cardiovasc Surg
(1985)- et al.
Impact of transhiatal esophagectomy on cardiac and respiratory function
Am J Surg
(1991) - et al.
Cardiovascular responses to manual dissection associated with transhiatal esophageal resection
J Cardiothorac Anesth
(1990) - et al.
Atrial fibrillation after esophagectomy is a marker for postoperative morbidity and mortality
J Thorac Cardiovasc Surg
(2003) - et al.
Symptomatic tachydysrhythmias after esophagectomyincidence and outcome measures
Ann Thorac Surg
(1996) - et al.
The history of surgery for carcinoma of the esophagus
Chest Surg Clin N Am
(2000) - et al.
Anaesthesia for gastrointestinal surgery
A preliminary report on anaesthesia for thoracoscopic oesophagectomy
Med J Malaysia
(1997)- et al.
Esophageal surgery
Cited by (18)
Gastric pull-up by the retrosternal route for esophageal replacement: Feasibility in a limited-resource scenario
2021, Journal of Pediatric SurgeryCitation Excerpt :Impaired cardiac filling has also been reported to be one of the causes. The need of beta-blockers has also been described for these arrhythmias [11–16]. The choice of route for gastric pull-up has to be based on the departmental and individual experience since there is no consensus yet among pediatric surgeons regarding the optimal route; whatever information is available in literature is based on small, mostly retrospective reports while well-designed comparative studies are lacking.
Approaches to perioperative care for esophagectomy
2015, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :Of note and concern to the treating anesthesiologist, the blunt dissection of the middle third of the esophagus can induce both arrhythmias as well as impair ventricular filling causing transient hypotension. Malhotra et al found that more than half of patients suffered intraoperative arrhythmias during mediastinal manipulation, and that degree of hypotension was correlated linearly with duration of manipulation.18 Much controversy exists as to the overall reduction in patient morbidity and mortality using the transhiatal esophagectomy (THE) approach.
Anesthetic Management for Esophageal Resection
2012, Anesthesiology ClinicsCitation Excerpt :Successful treatment may require esophageal or bronchial stenting or surgical repair. Cardiac arrhythmias are common in the postoperative period following major thoracic surgery in general and esophagectomy in particular.109,110 Postoperative new-onset supraventricular tachycardia (SVT) presents in 13% to 40% of patients needing esophagectomy.111–114
Perioperative Anesthetic Management for Esophagectomy
2008, Anesthesiology ClinicsCitation Excerpt :Perioperative arrhythmias have been reported in 20% to 60% of esophagectomies [6,7,10,13–15]. Although most are benign and may occur commonly during mediastinal manipulation in transhiatal esophagectomy [13], symptomatic arrhythmias may be associated with worse outcome [14,16]. Atrial fibrillation has been linked with pulmonary complications, anastomotic leakage, surgical sepsis [14], and supraventricular tachydysrhythmias with a higher rate of ICU admission and longer hospital stay [16].
Transhiatal Esophagectomy in the Profoundly Obese: Implications and Experience
2007, Annals of Thoracic SurgeryCitation Excerpt :In one report by Orringer and colleagues [15], mean intraoperative blood loss in 50 consecutive THE patients was 1166 mL from 1978 to 1980, 505 mL in 50 consecutive patients from 1991 to 1992, and 316 mL for 114 consecutive procedures from 1996 to 1997. A 2006 study on THE and arrhythmias incidentally reported an average blood loss of 620 mL [17]. The mean blood loss in this current study represents the continuing trend of improved hemostasis during the transhiatal mediastinal dissection owing to more direct clamping and ligating and cauterization of periesophageal tissue and less blunt dissection.