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Postoperative Myocardial Injury in Middle-Aged and Elderly Patients Following Curative Resection of Esophageal Cancer With Aggressive or Standard Body Temperature Management: A Randomized Controlled Trial

Zhang, Zuojing MM; Xu, Meiying BS; Wu, Dehua MD; Zhang, Xiaofeng MM; Wu, Jingxiang MD

doi: 10.1213/ANE.0000000000004022
Perioperative Medicine: Original Clinical Research Report
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BACKGROUND: Risk of intraoperative hypothermia is relatively high in middle-aged and elderly patients undergoing curative resection of esophageal cancer, which may cause myocardial ischemia during the early postoperative period. The objective of this study was to compare aggressive or standard body temperature management for lowering the incidence of postoperative myocardial injury that was assessed by troponin levels collected at a priori defined set times in these patients.

METHODS: Seventy patients undergoing elective curative resection of esophageal cancer were randomly assigned to undergo aggressive body temperature management (nasopharyngeal temperature ≥36°C) or standard body temperature management (n = 35 in each arm). The primary outcome was myocardial injury, defined as the occurrence of elevated troponin I (>0.06 µg/L) or elevated high-sensitivity troponin T (≥0.065, or 0.02 µg/L≤ high-sensitivity troponin T <0.065 µg/L, but with an absolute change of at least 0.005 µg/L) or both during 2 days after surgery. Secondary outcomes included (1) severe arrhythmia, including atrial fibrillation, supraventricular tachycardia, frequent premature ventricular contractions intraoperatively or during 3 days postoperatively; (2) hypoxemia or metabolic acidosis during the first 12 h postoperatively; and (3) deep vein thrombosis or pulmonary embolism during 3 days postoperatively.

RESULTS: Incidence of postoperative 2-day myocardial injury was 8.6% (3/35) among patients receiving aggressive body temperature management and 31.4% (11/35) among patients receiving standard body temperature management (P = .017, χ2). Relative risk of myocardial injury in the aggressive body temperature management group was 0.27 (95% CI, 0.08–0.89). Incidence of intra- and postoperative 3-day severe cardiac arrhythmia was 2.9% (1/35) among patients receiving aggressive body temperature management and 28.6% (10/35) among patients receiving standard body temperature management. Incidence of postoperative 12-h hypoxia was 17.1% (6/35) with aggressive body temperature management and 40.0% (14/35) with standard body temperature management. Incidence of postoperative 12-h metabolic acidosis was 20% (7/35) among patients receiving aggressive body temperature management and 48.6% (17/35) among patients receiving standard body temperature management. Incidence of postoperative 3-day deep vein thrombosis or pulmonary embolism was 0% (0/35) with aggressive body temperature management and 2.9% (1/35) with standard body temperature management.

CONCLUSIONS: Aggressive body temperature management may be associated with a lower incidence of postoperative myocardial injury.

From the Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.

Published ahead of print 12 December 2018.

Accepted for publication December 12, 2018.

Funding: This study was supported by the Shanghai Municipal Science and Technology Committee (Western Medicine Guide Projects No. 16411967600).

The authors declare no conflicts of interest.

Clinical trial registration number: ChiCTR-INR-17011621.

Registry URL: www.chictr.org.cn/showproj.aspx?proj=18675.

Reprints will not be available from the authors.

Address correspondence to Jingxiang Wu, MD, Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huaihai Rd W, Shanghai, China. Address e-mail to wjx1132@163.com.

Copyright © 2019 International Anesthesia Research Society
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