[Management of postoperative cardiovascular instability exemplified by esophageal surgery]

The postoperative course of 95 patients following esophagectomy was analyzed with regard to the occurrence of cardiac arrhythmias and circulatory instability. In 86 subjects (90%), post-operative atrial and ventricular arrhythmias were recorded. In all, 29 patients (30%), showed hypotonic episodes, with arterial mean pressures of less than 65 mmHg being recorded. Preloading was reduced in 8 cases, as was afterloading in 16 subjects, whereas in 5 patients actual cardiac failure occurred. There was a strong correlation between circulatory instability and postoperative surgical complications. All 24 subjects who developed surgical complications (that is, 80% of all patients exhibiting circulatory instability) experienced hypotonic episodes. In this group of patients, management should consist of a rational combination of vasoactive substances together with surgical removal of the focus. This analysis supports our proposition that in postoperative instability, one should always suspect initial, actual surgical complications and initiate adequate diagnostic and therapeutic measures.