Saran, Tajinder (2010) Arrhythmias in patients undergoing thoracotomies. MD thesis, University of Warwick.

Abstract

The aims of the thesis are to elucidate the incidence of post-operative supraventricular arrhythmias (SVA) in patients that undergo thoracotomy for lung or oesophageal resection in the local population and to determine risk factors associated with the development of SVA. Further objectives are to compare methods of SVA detection and to prospectively evaluate the role of magnesium sulphate as a preventative measure. The incidence of post-thoracotomy SVA in the local population was 25.5% which was found to be higher than reports in the literature. Yield of arrhythmia detection did not differ between continuous electrocardiogram monitoring and 12 lead electrocardiogram recordings. Risk factors identified were increasing age, the presence of ischaemic heart disease and hypertension, and undergoing a pneumonectomy. There was a trend towards a higher mortality in the group that developed an arrhythmia, in the pilot study. The amount of lung resected was also found to be significantly associated with an increasing incidence of SVA post-operatively. The prophylactic, peri-operative administration of intravenous magnesium sulphate did not reduce the incidence of SVA post-thoracotomy overall. The peripheral administration of magnesium sulphate was not well tolerated secondary to the minor side effect of stinging, although no major side effects such as respiratory depression were observed. However, it did significantly reduce the incidence of SVA in the higher risk cohort pneumonectomy subgroup. Further work is anticipated in this group along with further research into risk factors and aetiology.

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