The addition of clonidine 15 micro g to 6 mg of hyperbaric bupivacaine increases the spread of analgesia, prolongs the time to first analgesic request, and decreases postoperative pain, compared with bupivacaine alone, during inguinal herniorrhaphy under spinal anesthesia.

Introduction: Catheter ablation of atrial fibrillation (AF) has become an established therapy in the management of symptomatic AF. This systematic review aims to consolidate data of published literature to determine the frequency of acute complications of this procedure, and identify procedural predictors of adverse events.Methods: Databases were searched for English studies published up to 18th June 2012. 2065 references were evaluated for relevance by two independent reviewers. Reference lists of retrieved studies and pertinent review articles were also examined to ensure all relevant studies were included. Data was extracted from 192 studies, including a total of 83,236 patients.Results: The overall incidence of peri-procedural complications was 2.90% (95% CI, 2.60-3.22). There was a significant decrease in the acute complication rate over the last six years, 2007-2012, compared to the preceding six years, 2000-2006 (2.62% versus 4.01%, P = 0.003). The complication rate reported was higher in studies that prospectively defined complications they would identify, compared with studies that only retrospectively listed complications found (3.49% vs 2.70%, P = 0.028). No significant association was found between total procedure duration, radiofrequency energy application time, or the type of ablation strategy employed, and the acute complication rate.Conclusions: The acute complication rate of catheter ablation of AF has decreased significantly in recent years. This may reflect improved catheter technology and increased experience. The current use of different strate-gies across cardiovascular centers worldwide appears to be safe with no established relationship between the procedural variables studied and the complication rate. http://dx.

C atheter ablation of atrial fibrillation (AF) is an established rhythm control strategy in symptomatic AF. [1][2][3][4] The procedure aims to eliminate triggers and substrate that initiate, perpetuate, and sustain AF. Because catheter technology improves and experience increases, wider inclusion criteria are being used to select patients. Indeed, selected patients may benefit from ablation as first-line therapy. 5 A recent study reporting the outcomes of 2 meta-analyses found a 77% success rate for catheter ablation versus 52% for antiarrhythmic drugs. 6 Several randomized controlled trials have reported similar results.6-10 A meta-analysis of 4 of these studies found a >3.7-fold probability of freedom from AF with ablation compared with medical therapy. 11 Clinical Perspective on p 1088Catheter ablation can be associated with significant complications. Safety data reported from high-volume single-center series and the results of a recent international survey are inconsistent with regards to the incidence of acute complications ranging from <1% to 6%. [12][13][14][15][16][17] Furthermore, few studies have investigated the relationship between procedural variables and the complication rate. These have been limited to single-center series where low event rates have limited the identification of statistically significant predictors, and the applicability of results to other treatment settings is unclear.12, [14][15][16]18 The purpose of this review was to determine the incidence, temporal trends, and procedural predictors of complications associated with catheter ablation of AF. MethodsA literature search of the electronic databases, MEDLINE and EMBASE, was conducted on 18th June 2012 to identify all relevant studies describing complications of catheter ablation of AF. A detailed search methodology is presented in the online-only Data Supplement. This was supplemented by hand-searching bibliographies of retrieved articles as well as relevant review articles. Study SelectionStudies were eligible for the review if the participants were adults with symptomatic AF undergoing catheter ablation, and if complications were reported. Studies with both prospective and © 2013 American Heart Association, Inc. Gupta et al Complications of AF Ablation 1083retrospective designs were included. Abstracts, case reports, editorials, comments, conference proceedings, meta-analyses, and review articles were excluded. Studies involving surgical ablation, atrioventricular nodal ablation, exclusive right atrial ablation, or ablate-and-pace strategies were excluded. Animal and in vitro studies, as well as studies in languages other than English, were also excluded. Studies were included if there were ≥100 patients in the treatment arm. This minimum number was chosen to increase the likelihood of retrieving the best quality studies, as well as to exclude case reports and small series. These may have otherwise misrepresented the true incidence of rare adverse events by selectively reporting these cases in often niche patient subgroup...