Changes in blood pressure and heart rhythm during transhiatal esophagectomy

Esophagectomy is considered to be the main treatment for esophageal malignancies. Among the different methods, transhiatal approach can cause less damage to patients and is widely used; however, manipulation of esophagus result in heart rate and blood pressure variations. The aim of this study was to investigate changes in blood pressure and heart rhythm during transhiatal esophagectomy.

This prospective study was performed on 51 patients with esophageal cancer admitted for transhiatal esophagectomy. Anesthesia method was similar for all the patients. Blood pressure and heart rhythm were monitored in three stages; 30 min before, during, and up to 24 hours after mediastinal manipulation (blood pressure, every minute, and heart rhythm, continuously, were controlled during manipulation). Collected data were analyzed. Using SPSS statistical software Results: Over the first 5 minutes, systolic blood pressure declined significantly compared with preoperation time (p=0.001). Diastolic pressure declared from to 2 to 5 minutes postoperatively (p=0.001). Before mediastinal manipulation, AF was observed in 3 and PVC in 5 patients; whereas, arrhythmia was not found in other 43 patients. During mediastinal manipulation, 1, 25 and 10 patients developed AF, bradycardia and PVC respectively, and 4 patients had bradycardia and PVC, simultaneously. Arrhythmia was not detected in 11 patients. Before manipulation, arrhythmia was seen in 15.7% of patients which increased to 78.4% during operation time (p=0.0001).

According to the findings of this study the development of hypotension and arrhytmia are common during mediastinal manipulation. These changes recover after surgical procedure without treatment. If the alterations remain after surgery, remedial actions will be required.