Incidence and predictors of supraventricular dysrhythmias after pulmonary resection

Curtis, Jennifer; Parker, Brent M.; McKenney, Charlotte A.; Wagner‐Mann, Colette C.; Walls, Joseph T.; Demmy, Todd L.; Schmaltz, Richard A.

doi:10.1016/s0003-4975(98)00942-4

Cited by 64 publications

(46 citation statements)

References 11 publications

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“…It most commonly occurs on postoperative day 2 or 3, but can occur at any time during recovery [31]. The mechanism of atrial fibrillation after non-cardiac thoracic surgery is unknown, but there are multiple factors associated with developing post-operative atrial fibrillation.…”

Section: Atrial Fibrillationmentioning

confidence: 99%

Postlobectomy Early Complications

Ziarnik

Grogan

2015

Thoracic Surgery Clinics

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INTRODUCTIONThe most effective management of postoperative crises is prevention. This starts with preoperative preparation and patient screening. There are many factors that can be controlled and improved by the patient, including but not limited to, smoking cessation, cardiopulmonary rehab and teaching/setting peri-operative expectations. Equally as important is patient selection, which is influenced by pulmonary function tests, cardiopulmonary reserve, and pre-existing comorbidities. After the operation, the care team can also greatly improve outcomes with aggressive cardiopulmonary therapies, ambulation, vigilant monitoring and frequent assessments of the patient. Even when all of these guidelines are followed not all early complications can be avoided.A recent review of the National Cancer Database by Rosen et al found a 2.6% mortality from lobectomy [1]. Morbidity associated with lobectomy is 10% to 50%, and increases in the elderly [2]. The population being treated by thoracic surgeons continues to age and the complexity of the operations is increasing as neoadjuvant therapies become more prevalent. Early postoperative crises after lobectomy will occur, necessitating prompt and effective management strategies. The most common complications after pulmonary resection are listed below in Table 1, in this chapter we will focus on the early complications after lobectomy [3].For the purposes of this chapter we will define early post-operative crisis as those that develop within 48 hours of the operation. AIR LEAKProlonged air leak is the most common complication after pulmonary resection, with a reported incidence of 15-18% [4]. Prolonged air leak is defined as a leak lasted more than 7 days after pulmonary resection. Cerfolio et al reported an incidence of 25% on postoperative day 1 and 20% on postoperative day 2 [5,6] U.S. Department of Veterans AffairsPublic Access Author manuscript VA Author ManuscriptVA Author Manuscript VA Author Manuscript parenchymal air leaks post-operatively and a variety of factors that influence any given patients propensity for developing an air leak. Patient factors that increase risk of developing an air leak include emphysematous lungs, larger parenchymal resection and therefore less parenchymal apposition to chest wall, and inadequate drainage of air by thoracostomy tube(s). PREVENTION STRATEGIES1. Bronchial stump buttressing with a muscle flap. In patients with an infected pleural space or who are on chronic immunosuppression, coverage of the stump with vascularized muscle may prevent bronchial stump breakdown [7]. The intercostal muscle is an excellent coverage option and is harvested from the intercostal space upon entry into the chest at the level of the thoracotomy. It is important to plan ahead, as this muscle needs to be harvested prior to placing the rib spreader in an open operation to prevent crushing the vascular supply. Dissection is begun on the inferior rib and the muscle is mobilized using a periosteal elevator posteriorly to the paraspinous muscle. Attention is...

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Section: Atrial Fibrillationmentioning

confidence: 99%

Postlobectomy Early Complications

Ziarnik

Grogan

2015

Thoracic Surgery Clinics

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“…AF occurs in 10-40 % of pulmonary resection patients and has a peak incidence on the second to third day after surgery [5,9]. Studies demonstrate that advanced age, male sex, arterial hypertension, ischemic heart disease, heart failure, clamshell incision, and resection of the right lung are significant risk factors for AF after lung surgery, and respiratory and infectious complications are involved in the occurrence of temporally linked AF [7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that its occurrence, including atrial fibrillation (AF) and paroxysmal supraventricular tachycardia (PSVT), increases postoperative complications and mortality rates [3][4][5][6][7][8][9][10]. Postoperative tachyarrhythmia is associated with delayed early mobilization, prolonged postoperative hospital stay, and increased medical costs of open thoracic operations [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Predictive factors for postoperative tachyarrhythmia after thoracoscopic esophagectomy and the usefulness of landiolol hydrochloride for its treatment

et al. 2013

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Background Tachyarrhythmia after esophagectomy is a severe complication that should not be underestimated because of its negative impact. The aims of this study were to clarify the cause and impact of postoperative tachyarrhythmia after thoracoscopic esophagectomy. Additionally, we analyzed the usefulness of landiolol administration for postoperative tachyarrhythmia. Methods We evaluated the predictive factors for tachyarrhythmia onset after surgery and its clinical impact in 127 patients who underwent thoracoscopic esophagectomy with extended lymphadenectomy. Moreover, we analyzed the efficacy of landiolol for postoperative tachyarrhythmia. Results Tachyarrhythmia developed in 38 of the 127 patients. Multivariate analysis showed that advanced age, heart disease, and hyperlipidemia were associated with postoperative tachyarrhythmia. Hyponatremia, hypoalbuminemia, and leukocytosis on postoperative day 3 were significantly associated with tachyarrhythmia onset. The incidence of all complications and respiratory complications, including pneumonia, was significantly higher in patients with than in those without tachyarrhythmia. The mortality rate in the tachyarrhythmia group tended to be higher than that in the nontachyarrhythmia group. Landiolol as a treatment for tachyarrhythmia immediately decreased heart rate and safely reduced subsequent respiratory complications. ConclusionIn elderly patients with cardiac disease or hyperlipidemia, surgeons should be alert for the occurrence of tachyarrhythmia after esophagectomy. Postoperative tachyarrhythmia is a marker of morbidities with particular emphasis on respiratory complications. However, it can be adequately managed by landiolol, resulting in fewer respiratory complications. Landiolol might be a safe and convenient agent for managing postoperative tachyarrhythmia after thoracoscopic esophagectomy, resulting in lower mortality and morbidity rates.

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“…Postoperatif atriyal fibrilasyonda izlenecek yol [11] . [21][22][23][24] . Akciğer rezeksiyonundan sonra AF oluşumunu önlemek için amiodarone, MgSO 4 , digoksin, ve Ca2…”

Section: Postoperatif Gün +5unclassified

Anesteziyolog Bakış Açısından Atriyal Fibrilasyon

Kabukçu¹,

Şahin²,

Titiz³

2017

GKDA Derg

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ÖZ GiRiŞAtriyal fibrilasyon (AF) en sık görülen kardiyak aritmidir, atriyal miyositlerdeki elektiriksel aktivitenin bozukluğu ile oluşur. AF serebral tromboemboli zemininde inme ve diğer tromboembolik olaylar, sol ventrikül fonksiyon bozukluğu, kalp yetmezliği gibi mortaliteyi artıran ciddi komplikasyonlar ile birliktedir. Ayrıca hastaneye yatış oranında artma, yaşam kalitesinin bozulması ve egzersiz kapasitesinin azalması gibi nedenlerle morbiditeyi etkilemektedir [1] . AF genel popülasyonun %1-2'sinde ve görülme sıklığı 40-50 yaş aralığındadır. Yaşla birlikte artmakta ve 80 yaşında % 5-15 oranına ulaşmaktadır [2][3][4][5][6] . Erkekler kadınlardan daha fazla etkilenmektedir [7] .EKG'de P dalgalarının yokluğu ve düzensiz RR aralı-ğı saptanması ile AF tanısı konur. Aritminin başlangıç ve seyrine göre paroksismal, ısrarcı ve kalıcı olmak üzere üç sekilde sınıflandırılır. Paroksismal AF 48 saat içinde genellikle kendiliğinden düzelir. Israrcı AF 1 haftadan 1 yıla kadar sürebilir, kendiliğinden düzelmez medikal veya doğru akım (DC) kardiyoversiyon ile sinüs ritmine döndürülebilir (Tablo 1). Kalıcı AF'de medikal veya kardiyoversiyon ile sinüs ritmine dönüş olası olmaz [1,8,9] . AF tanısı EKG ile kolaylıkla konmasına rağmen, birçok hastada asemptomatiktir. Komplikasyonlar gelişene kadar tanı konamayabilir. AF nedeni kardiyovasküler veya değildir. Örneğin, geçirilmiş miyokard infarktüsü, kardiyomiyopati, hipertansiyon, kapak hastalıkları ve kalp yetmezliği kardiyovasküler nedenlerdir. Diyabet, obezite, alkol, hipertiroidi, KOAH ve diğer metabolik bozukluklar ise diğer AF nedenleridir [8,10] .Preoperatif AF tanısı alan hastada anestezist, semptomları hafifletme, hemodinamik stabiliteyi devam ettirme ve kardiyopulmoner komplikasyonları önle-meye odaklanmalıdır. Cerrah ile birlikte anestezist, cerrahiye devam kararına varmadan önce kalp açısın-dan temel laboratuvar ve görüntüleme tetkiklerinin gerekliliğine karar vermelidir [1,11] .

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Incidence and predictors of supraventricular dysrhythmias after pulmonary resection

Cited by 64 publications

References 11 publications

Postlobectomy Early Complications

Postlobectomy Early Complications

Predictive factors for postoperative tachyarrhythmia after thoracoscopic esophagectomy and the usefulness of landiolol hydrochloride for its treatment

Anesteziyolog Bakış Açısından Atriyal Fibrilasyon

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