JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (18) Citing Articles via Google Scholar Google Scholar Articles by Oka, T. Articles by Ohkubo, Y. Search for Related Content PubMed PubMed Citation Articles by Oka, T. Articles by Ohkubo, Y. Related Collections Heart Monitoring (Cardiac) Regional Anesthesia

---

CARDIOVASCULAR ANESTHESIA

Thoracic Epidural Bupivacaine Attenuates Supraventricular Tachyarrhythmias After Pulmonary Resection

Division of Anesthesia, Tochigi Cancer Center Hospital, Tochigi, Japan

Address correspondence and reprint requests to Dr. Tatsuhiro Oka, Division of Anesthesia, Tochigi Cancer Center Hospital, 4-9-13 Yohnan, Utsunomiya-shi, Tochigi 320-0834, Japan. Address e-mail to toka{at}tcc.pref.tochigi.jp

Supraventricular tachyarrhythmias after pulmonary surgery are well described. Some investigators suggest that tachyarrhythmias after thoracic operations may result from the relative sympathotonic status produced by injury to the cardiac parasympathetic nerves. We examined whether postoperative thoracic sympathetic blockade by thoracic epidural bupivacaine might reduce the tachyarrhythmias after pulmonary resection. Fifty patients with lung cancer were randomized to receive epidural bupivacaine (Group B) or epidural morphine (Group M). Patients in Group B were given 6 to 10 mL of 0.25% bupivacaine epidurally, followed by epidural infusion at 3 to 5 mL/h for 3 days, and patients in Group M were given 2 to 3 mg morphine epidurally, followed by morphine infusion at a rate of 0.2 mg/h. Tachyarrhythmias were diagnosed by using the continuous heart rate trend and arrhythmia trend with a central monitoring system. Postoperative analgesia was not statistically different between groups. However, the incidence of postoperative tachyarrhythmias in Group B was significantly less than in Group M (1 of 23 vs 7 of 25, P = 0.0497, Fisher’s exact test). The continuous infusion of thoracic epidural bupivacaine can reduce supraventricular tachyarrhythmias compared with epidural morphine infusion, presumably because of attenuation of the sympathotonic status after pulmonary resection.

IMPLICATIONS: We examined whether postoperative thoracic sympathetic blockade by thoracic epidural bupivacaine after pulmonary resection might reduce the tachyarrhythmias that may result from the relative sympathotonic status produced by injury to the cardiac parasympathetic nerves. The continuous infusion of thoracic epidural bupivacaine was shown to reduce supraventricular tachyarrhythmias.

This article has been cited by other articles:

				D. P. Mason, D. H. Marsh, J. M. Alster, S. C. Murthy, A. M. McNeill, M. M. Budev, A. C. Mehta, G. B. Pettersson, and E. H. Blackstone Atrial Fibrillation After Lung Transplantation: Timing, Risk Factors, and Treatment Ann. Thorac. Surg., December 1, 2007; 84(6): 1878 - 1884. [Abstract] [Full Text] [PDF]

				A. Ng and J. Swanevelder Pain relief after thoracotomy: is epidural analgesia the optimal technique? Br. J. Anaesth., February 1, 2007; 98(2): 159 - 162. [Full Text] [PDF]

				J. Dunning, T. Treasure, M. Versteegh, S. A.M. Nashef, and on behalf of the EACTS Audit and Guidelines Commit Guidelines on the prevention and management of de novo atrial fibrillation after cardiac and thoracic surgery Eur. J. Cardiothorac. Surg., December 1, 2006; 30(6): 852 - 872. [Full Text] [PDF]

				H. J. Ahn, W. S. Sim, Y. M. Shim, and J. A. Kim Thoracic epidural anesthesia does not improve the incidence of arrhythmias after transthoracic esophagectomy Eur. J. Cardiothorac. Surg., July 1, 2005; 28(1): 19 - 21. [Abstract] [Full Text] [PDF]

				V. Shrivastava, B. Nyawo, J. Dunning, and G. Morritt Is there a role for prophylaxis against atrial fibrillation for patients undergoing lung surgery? Interactive CardioVascular and Thoracic Surgery, December 1, 2004; 3(4): 656 - 662. [Abstract] [Full Text] [PDF]

				R. G. Soto and E. S. Fu Acute pain management for patients undergoing thoracotomy Ann. Thorac. Surg., April 1, 2003; 75(4): 1349 - 1357. [Abstract] [Full Text] [PDF]

				D. Amar, H. Zhang, and N. Roistacher The Incidence and Outcome of Ventricular Arrhythmias After Noncardiac Thoracic Surgery Anesth. Analg., September 1, 2002; 95(3): 537 - 543. [Abstract] [Full Text] [PDF]

				S. M. Neustein, D. Krellenstein, E. Cohen, and T. Oka Arrhythmias After Video Assist Thoracoscopy * Response Anesth. Analg., May 1, 2002; 94(5): 1372 - 1372. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999