Comparison of development of intraoperative atrial fibrillation in elderly patients undergoing thoracic surgery using different anesthetic methods: a large sample clinical trial

Abstract

Objective To compare the development of intraoperative atrial fibrillation in elderly patients undergoing thoracic surgery using different anesthetic methods in a large sample clinical trial. Methods A total of 1 380 patients of both sexes, aged 60-80 yr, with body mass index of 16-33 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective radical operations for lung or esophageal cancer, were divided into 3 groups(n=460 each)using a random number table: general anesthesia group(group G), general anesthesia combined with paravertebral block group(group GP), and general anesthesia combined with epidural block group(group GE). After induction of anesthesia, an epidural catheter was placed at T4-7 interspace on the operated side, and 0.375% ropivacaine 8 ml was administrated via the catheter in group GP.After induction of anesthesia, the patients were tracheally intubated and mechanically ventilated, and the end-tidal pressure of carbon dioxide was maintained at 35-45 mmHg in the 3 groups.Maintenance of anesthesia was as follows: propofol was given by target-controlled infusion with the target plasma concentration of 2.5-4.0 μg/ml in the 3 groups; intermittent iv boluses of sufentanil 10 μg were given, and the total dosage was not expected to exceed 1.0 μg/kg in group G; sufentanil 10 μg was injected intravenously when necessary in group GP; 0.25% ropivacaine 5 ml was injected epidurally every 1.5 h in group GE; bispectral index value was maintained at 40-60; rocuronium was injected intravenously according to the condition in the 3 groups.The development of intraoperative atrial fibrillation was recorded. Results The incidence of intraoperative atrial fibrillation was 6.1%, 3.7% and 2.2% in G, GP and GE groups, respectively.Compared with group G, the incidence of intraoperative atrial fibrillation was significantly decreased in group GE(P 0.05). Conclusion Compared with general anesthesia, general anesthesia combined with epidural block can decrease the development of intraoperative atrial fibrillation, it is more suitable for this type of patients, however, general anesthesia combined with paravertebral block produces no improvement in the development of intraoperative atrial fibrillation in elderly patients undergoing thoracic surgery. Key words: Atrial fibrillation; Anesthesia, general; Nerve block; Thoracic vertebrae; Anesthesia, epidural; Thoracic surgical procedures; Aged