title: Incidence and Risk Factors of an Intraoperative Arrhythmia in Transhiatal Esophagectomy.
abstract: BACKGROUND
  Transhiatal esophagectomy (THE) is a widely used technique for carcinoma of the esophagus and other conditions, such as benign strictures and motility disorders.
  
  
  OBJECTIVE
  The aim of our study was to quantify the incidence, predisposing factors, as well as types of arrhythmias in transhiatal esophagectomy.
  
  
  METHODS
  In this prospective study, we selected 61 patients undergoing transhiatal esophagectomy during 2012 - 2013 in our hospital. The demographic information, site of the tumor, cardiopulmonary function, transfusion, preoperative and postoperative complications (i.e. arrhythmias, hypotension), operation time, duration of mediastinal manipulation, amount of hemorrhage, volume loss, volume intake, mean systolic and diastolic pressure, and death rate were evaluated by chi-square, Fisher's exact test, ANOVA, and t-tests.
  
  
  RESULTS
  The mean age of patients was 61.24 ± 11.48. In the study group, 8.2% of the patients before, 50.8% during, and 11.2% after mediastinal manipulation showed arrhythmia. Tumor location, the need for transfusion, pathology of the tumor, presence of arrhythmia before the operation, FEV1 (Forced Expiratory Volume) > 2 liters, and mean volume intake were significantly different between the patients with and without arrhythmia. Hypotension was shown in 8.2% of the patients before and 57.7% during mediastinal manipulation. Manipulation times, volume loss, mean systolic and diastolic blood pressure before the operation, and FEV1 > 2 liters were statistically significant in occurrence of hypotension.
  
  
  CONCLUSIONS
  Our data showed that the amount of hydration, transfusion, pre-manipulation arrhythmia, and pulmonary function should be controlled to decrease the risk of arrhythmias. Minor mediastinal manipulation, few intraoperative hemorrhages, improvement of pulmonary function, and careful blood pressure monitoring can reduce the risk of hypotension.
authors.affiliation: Department of Surgery, Madani Hospital, Alborz University of Medical Sciences, Karaj, IR Iran.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Ahmadinejad
authors.affiliation: Department of Surgery, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, IR Iran.
authors.forename: Mozaffar
authors.initials: M
authors.lastname: Hashemi
authors.affiliation: Department of Surgery, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, IR Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Tabatabai
authors.affiliation: Department of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran.
authors.forename: Shahram
authors.initials: S
authors.lastname: Keykha
authors.affiliation: Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, IR Iran.
authors.forename: Zabihollah
authors.initials: Z
authors.lastname: Taleshi
authors.affiliation: Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, IR Iran.
authors.forename: Koorosh
authors.initials: K
authors.lastname: Ahmadi
keywords: Arrhythmia; Hypotension; Transhiatal Esophagectomy