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Thoracic epidural analgesia: its role in postthoracotomy atrial arrhythmias
L Groban1, S Y Dolinski, D A Zvara
1Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1009, USA.
Objective:
To determine the effects of thoracic epidural analgesia (TEA) management on the incidence of atrial arrhythmias (AAs) after thoracotomy for lung resection.
Design:
Retrospective.
Setting:
A major university medical center.
Participants:
The medical records of 185 consecutive patients who underwent thoracotomy between 1993 and 1997 were reviewed; patients with TEA only were included in the analysis.
Interventions:
None.
Measurements And Main Results:
There was a 20% incidence of AAs after thoracotomy. Preoperative predictors of AAs were age >65 years, cardiac history, and an abnormal electrocardiogram (ECG). There was a temporal relationship between epidural catheter removal and occurrence of AAs. Fourteen patients developed AAs before TEA catheter removal, whereas 29 patients developed AAs after TEA catheter removal (p = 0.01). There was no relationship between anatomic site of epidural catheter placement or choice of epidural agent and AAs.
Conclusions:
AAs after thoracotomy were common. These AAs were associated with increased age, cardiac history, abnormal ECG, increased cost, increased length of hospital stay, and time of epidural catheter removal. Although a cause-and-effect relationship cannot be inferred from this study, the presence or absence of TEA was found to have a temporal relationship with the incidence of AAs.
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