Atrial Fibrillation Prophylaxis is Recommended in Patients Undergoing Major Thoracic Surgery
Atrial Fibrillation Prophylaxis is Recommended in Patients Undergoing Major Thoracic Surgery
ANESTHESIOLOGY HAS MADE the use of systematic processes, review of prior errors, and technology evolve into a model of safety in medicine. The risk of intraoperative complications related to anesthesia is low, and with an increased focus on “value-based” care, anesthesiologists must direct their attention toward the entire perioperative scope of patient care. For patients undergoing major thoracic surgery, postoperative atrial fibrillation (POAF) is a specific complication that may be avoided if attention is paid to prophylaxis strategies. The authors believe that prophylaxis is effective, safe, and recommended after major thoracic surgery. Many anesthesiologists participate in the care of patients undergoing major thoracic surgeries, and POAF is an undesired but common occurrence in the postoperative period. The risk of POAF is more than 15% in several major thoracic procedures, including thoracoscopic lobectomy, open lobectomy, pneumonectomy, lung transplantation, and esophagectomy, and may be as high as 67% after pneumonectomy. The associated deleterious effects of atrial fibrillation are well described and include structural heart change, potential hemodynamic instability, intracardiac thrombus formation leading to stroke, and anticoagulation requirements. Additionally, POAF brings with it the risks of increased hospital length of stay and increased hospital costs. Despite randomized controlled trials and meta-analyses that provided evidence of the efficacy of POAF prophylaxis for this surgical population, a common argument against the routine or protocolized use of these medications is concern regarding untoward side effects and unwanted safety profile. A closer look into the reported complications and side effects associated with the most effective prophylaxis agents (ie, beta-blockers and amiodarone) does not support the outright withholding of these agents.
