Title: Arrhythmias After Video Assist Thoracoscopy
Abstract:In Response: I thank Dr. Neustein for his comments regarding our study and appreciate the opportunity to reply. I read with interest the clinical report of Neustein et al. (1) describing arrhythmias a...In Response: I thank Dr. Neustein for his comments regarding our study and appreciate the opportunity to reply. I read with interest the clinical report of Neustein et al. (1) describing arrhythmias after video-assisted thoracoscopy (VAT). I agree with Neustein et al. (1) that the incidence of postoperative arrhythmias was less frequent in patients who underwent VAT and received epidural analgesia compared with patients who did not have epidural analgesia. However, they reported that postoperative epidural analgesia did not affect the incidence of postoperative arrhythmias in the thoracotomy group. Moreover, their study did not assess the pain intensity. Therefore, I do not agree that only the pain relief by epidural analgesia decreased postoperative tachyarrhythmias. We indicated that the continuous infusion of thoracic epidural bupivacaine reduced supraventricular tachyarrhythmias compared with continuous epidural morphine infusion in postoperative periods, although there was no significant difference in pain intensity between the arrhythmias (+) group and arrhythmias (-) group (2). They suggested that the incidence of postoperative arrhythmias was not statistically different between patients who underwent VAT and those who underwent thoracotomy, although all patients who had either pneumonectomy or lobectomy had a thoracotomy incision. Thoracotomy is one of the procedures associated with the most severe postoperative pain (3). The extent of pulmonary resection has been considered a risk factor of postoperative arrhythmias (4). Therefore, I suppose that this result may be caused by the difference in distribution of age between two groups. Their study design was a retrospective investigation and the possible risk factors for postoperative arrhythmias were not assessed by a multivariate statistical analysis. A randomized controlled study is necessary to assess the effects of epidural analgesia on postoperative tachyarrhythmias after VAT. Tatsuhiro OkaRead More