title: Thoracic epidural analgesia: its role in postthoracotomy atrial arrhythmias.
abstract: OBJECTIVE
  To determine the effects of thoracic epidural analgesia (TEA) management on the incidence of atrial arrhythmias (AAs) after thoracotomy for lung resection.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  A major university medical center.
  
  
  METHODS
  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.
  
  
  METHODS
  None.
  
  
  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.
authors.affiliation: Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1009, USA.
authors.forename: L
authors.initials: L
authors.lastname: Groban
authors.forename: S Y
authors.initials: SY
authors.lastname: Dolinski
authors.forename: D A
authors.initials: DA
authors.lastname: Zvara
authors.forename: T
authors.initials: T
authors.lastname: Oaks
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural; D001145:Arrhythmias, Cardiac / Q000453:epidemiology*; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D013510:Pulmonary Surgical Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D013908:Thoracotomy; D013997:Time Factors