ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

Fleisher, Lee A.; Beckman, Joshua A.; Brown, Kenneth A.; Calkins, Hugh; Chaikof, Elliott; Fleischmann, Kirsten E.; Freeman, William K.; Froehlich, James B.; Kasper, Edward K.; Kersten, Judy R.; Riegel, Bárbara; Robb, John F.; Smith, Sidney C.; Jacobs, Alice K.; Adams, Cynthia D.; Anderson, Jeffrey L.; Antman, Elliott M.; Buller, Christopher E.; Creager, Mark A.; Ettinger, Steven M.; Faxon, David P.; Fuster, Valentín; Halperin, Jonathan L.; Hiratzka, Loren F.; Hunt, Sharon A.; Lytle, Bruce W.; Nishimura, Rick A.; Ornato, Joseph P.; Page, Richard L.; Tarkington, Lynn G.; Yancy, Clyde W.

doi:10.1016/j.jacc.2007.09.003

Cited by 697 publications

(147 citation statements)

References 606 publications

(417 reference statements)

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“…Although there are guidelines for intraoperative cardiovascular evaluation of patients [5], less is known about the effect on the surgeon. Sharma et al [14] monitored physiologic parameters using an oscillometric monitor during neurosurgery and compared the intraoperative values recorded with an exercise-related stress response.…”

Section: Introductionmentioning

confidence: 99%

Does Orthopaedic Surgical Training Induce Hypertension? A Pilot Study

Gupta

Carter

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Elevated blood pressure (BP) is associated with increased cardiovascular risks manifested by ischemic heart disease and stroke. Studies of cardiothoracic surgeons and neurosurgeons suggest surgery induces a hemodynamic stress malresponse. However, it is unclear whether these occur in orthopaedic surgeons. Questions/Purposes We measured the BP of surgeons during hallux valgus surgery, TKA, and THA with the: (1) trainee assisting the trainer, (2) the trainer assisting the trainee, (3) the trainee operating independently, and (4) compared the intraoperative changes in BP and heart rate of orthopaedic surgeons with those of a clinic day and during an exercise tolerance test.Methods We used an ambulatory BP monitor to measure the BP and heart rate of three consultants and their respective trainees during hallux valgus surgery, TKA, or THA. We noted if there were any differences in the stress response of the lead surgeon in comparison to when the same individual was assisting a trainee, and vice versa. Additionally, we recorded the trainee's BP and heart rate when they were operating independently. The intraoperative changes in BP and heart rate of orthopaedic surgeons were compared with those measured during a clinic day and during an exercise tolerance test. Results When the trainer was leading the operation, their mean arterial pressure gradually increased to 105 (range, 102-109) until implant placement. However, when the trainee was operating and the trainer assisting, the trainer's BP peaked (mean, 101; range, 95-111) at the beginning of the procedure and slowly declined as it progressed. The trainee's BP remained elevated throughout. The highest peaks for trainees were noted during independent operating. All of the surgeons had higher average BP readings (mean, 100; range, 95-108) and heart rate (mean, 86; range, 57-117) on days when they did surgery compared with baseline. Conclusions The elective operations studied induced a hypertensive response. The response was more marked in trainees than in trainers, particularly if the trainee was operating independently.

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Section: Introductionmentioning

confidence: 99%

Does Orthopaedic Surgical Training Induce Hypertension? A Pilot Study

Gupta

Carter

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…Routine perioperative TEE in noncardiac surgery may be indicated in cardiovascular unstable patients or those with cardiac disease who are likely to require cardiovascular support. [8][9][10][11] The benefits of perioperative TEE need to be weighed against its risks. TEE is an invasive imaging method and carries a low incidence of complications, such as odynophagia, dental injury, upper-gastrointestinal haemorrhage and oesophageal perforation.…”

Section: Discussionmentioning

confidence: 99%

The use of intraoperative transoesophageal echocardiography as a monitor for haemodynamic instability during pulmonary hydatid cyst excision

Picken

Myburgh

2013

Southern African Journal of Anaesthesia and Analgesia

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We present the case of a patient with bilateral, pulmonary hydatid cysts who presented for cystectomy and developed life-threatening, haemodynamic instability when turned into the lateral decubitus position. Intraoperative transoesophageal echocardiography allowed for rapid interpretation of the haemodynamic collapse and proved to be valuable in surgical and anaesthetic decision-making. Human immunodeficiency virus co-infection in patients with Echinococcus infection has been implicated in the development of a more severe and disseminated clinical course in hydatid disease.

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“…Furthermore, it has been suggested in several clinical trials that inhalational anaesthetic agents may be beneficial over intravenous agents in patients undergoing cardiac surgery, although debate still exists 102, 103. In 2007, the American Heart Association, along with the Society of Cardiovascular Anesthesiologists, recommended that patients with a history of cardiac disease should preferably be anaesthetised with a volatile anaesthetic agent 104. However, a recent clinical trial failed to support this recommendation 105.…”

Section: Ric and The Role Of Anaesthetic Agentsmentioning

confidence: 99%

Remote ischaemic conditioning: cardiac protection from afar

2015

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For patients with ischaemic heart disease, remote ischaemic conditioning may offer an innovative, non‐invasive and virtually cost‐free therapy for protecting the myocardium against the detrimental effects of acute ischaemia‐reperfusion injury, preserving cardiac function and improving clinical outcomes. The intriguing phenomenon of remote ischaemic conditioning was first discovered over 20 years ago, when it was shown that the heart could be rendered resistant to acute ischaemia‐reperfusion injury by applying one or more cycles of brief ischaemia and reperfusion to an organ or tissue away from the heart – initially termed ‘cardioprotection at a distance’. Subsequent pre‐clinical and then clinical studies made the important discovery that remote ischaemic conditioning could be elicited non‐invasively, by inducing brief ischaemia and reperfusion to the upper or lower limb using a cuff. The actual mechanism underlying remote ischaemic conditioning cardioprotection remains unclear, although a neuro‐hormonal pathway has been implicated. Since its initial discovery in 1993, the first proof‐of‐concept clinical studies of remote ischaemic conditioning followed in 2006, and now multicentre clinical outcome studies are underway. In this review article, we explore the potential mechanisms underlying this academic curiosity, and assess the success of its application in the clinical setting.

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ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

Cited by 697 publications

References 606 publications

Does Orthopaedic Surgical Training Induce Hypertension? A Pilot Study

Does Orthopaedic Surgical Training Induce Hypertension? A Pilot Study

The use of intraoperative transoesophageal echocardiography as a monitor for haemodynamic instability during pulmonary hydatid cyst excision

Remote ischaemic conditioning: cardiac protection from afar

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