Early and Delayed Myocardial Infarction after Abdominal Aortic Surgery

Manach, Yannick Le; Perel, Azriel; Coriat, Pierre; Godet, G.; Bertrand, Michèle; Riou, Bruno

doi:10.1097/00000542-200505000-00004

Cited by 203 publications

(131 citation statements)

References 30 publications

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“…The administration of an anticholinergic did not reduce the incidence of bradycardia (p = 0. 43). An analysis of vascular surgical patients alone showed a significant increase in hypotension and a trend to an increase in bradycardia, although the confidence intervals for both of these side-effects overlap with the adverse drug events reported for the entire meta-analysis.…”

Section: Effect Of Peri-operative Dexmedetomidinementioning

confidence: 99%

“…However, a number of important mistakes made in studies of peri-operative beta-blockade (and evident in the trials in this meta-analysis of dexmedetomidine) should be avoided when designing a peri-operative study of cardiac outcomes following the use of dexmedetomidine in non-cardiac surgery. The patients selected should present sufficient cardiac risk, the dosage regimen should ensure adrenergic blockade at least for 72 h postoperatively and preferably longer [43], and finally heart rate should be considered an important therapeutic target [44].…”

Section: ó 2008 the Authorsmentioning

confidence: 99%

See 1 more Smart Citation

Dexmedetomidine and cardiac protection for non‐cardiac surgery: a meta‐analysis of randomised controlled trials

Biccard¹,

Goga²,

Beurs³

2007

Anaesthesia

122

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SummaryWe conducted a systematic review of the effects of dexmedetomidine on cardiac outcomes following non-cardiac surgery. We included prospective, randomised peri-operative studies of dexmedetomidine that reported mortality, cardiac morbidity or adverse drug events. A PubMed Central and EMBASE search was conducted up to July 2007. The reference lists of identified papers were examined for further trials. Of 425 studies identified, 20 were included in the metaanalysis (840 patients). Dexmedetomidine was associated with a trend towards improved cardiac outcomes; all-cause mortality (OR 0.27, 95% CI 0.01-7.13, p = 0.44), non-fatal myocardial infarction (OR 0.26, 95% CI 0.04-1.60, p = 0.14), and myocardial ischaemia (OR 0.65, 95% CI 0.26-1.63, p = 0.36). Peri-operative hypotension (26%, OR 3.80, 95% CI 1.91-7.54, p = 0.0001) and bradycardia (17%, OR 5.45, 95% CI 2.98-9.95, p < 0.00001) were significantly increased. An anticholinergic did not reduce the incidence of bradycardia (p = 0.43). A randomised placebocontrolled trial of dexmedetomidine is warranted. Major peri-operative cardiac events (cardiac death, nonfatal myocardial infarction and non-fatal cardiac arrest) have been reported in 1.4% of unselected patients undergoing elective non-cardiac surgery [1,2] and between 2.6 and 5.8% in selected patients considered to be at risk of cardiac disease [1]. Peri-operative cardiac events are approximately evenly distributed between myocardial oxygen supply demand imbalance and plaque rupture [3,4]. In addition, these cardiac events may be precipitated by a number of potential triggers in the perioperative period, including inflammation, surgical stress, hypercoagulable states and peri-operative hypoxic episodes [1]. It has therefore been estimated that, at best, a single medical therapy could be expected to result in a relative risk reduction of 20-35% for the composite endpoint of cardiac death, non-fatal myocardial infarction and non-fatal cardiac arrest in the peri-operative period [2].There has been considerable interest in the utility of adrenergic antagonists in decreasing peri-operative cardiac events. Beta-adrenergic antagonists decrease peri-operative myocardial ischaemia, although it is controversial whether this results in an improved cardiac outcome [5,6]. In addition, beta-adrenergic antagonists significantly increase the incidence of drug-associated hypotension and bradycardia which require treatment [6]. It is unclear whether these side-effects adversely affect the cardioprotective efficacy of peri-operative beta-blockade.Unfortunately, some patients may not realise the potential cardioprotective benefits of peri-operative beta-blockade, as this may be either contra-indicated or difficult to initiate in the peri-operative period in patients with active bronchospasm, conduction disorders or decompensated cardiac failure. Alpha-2 agonists may be an alternative anti-adrenergic therapy in these patients. Alpha-2 agonists decrease central noradrenergic activity of the locus coeruleus [7] with a decrease in...

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Section: Effect Of Peri-operative Dexmedetomidinementioning

confidence: 99%

Section: ó 2008 the Authorsmentioning

confidence: 99%

Dexmedetomidine and cardiac protection for non‐cardiac surgery: a meta‐analysis of randomised controlled trials

Biccard¹,

Goga²,

Beurs³

2007

Anaesthesia

122

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“…17,18) Therefore, as suggested previously, the introduction of postoperative monitoring of troponin as a standard protocol might be feasible. 19) Troponin-I elevation can occur after noncardiac surgery in patients without coronary artery disease.…”

Section: )mentioning

confidence: 97%

Troponin-I Level After Major Noncardiac Surgery and Its Association With Long-Term Mortality

et al. 2016

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SummaryIndividuals with intermediate to high cardiac risk for major noncardiac surgery suffer from perioperative myocardial ischemic injury. The purpose of this study was to evaluate the long-term impact of postoperative cardiac troponin elevation on clinical outcome after major noncardiac surgery.Patients (n = 750) aged ≥ 50 years who underwent major noncardiac surgery were eligible for the study. Postoperative cardiac troponin-I data were collected retrospectively and consecutively. The primary outcome measure was allcause mortality. The median follow-up period was 1727 days in all patients.Among 750 patients, 92 (12.2%) showed elevated postoperative troponin-I above 0.10 ng/mL. Operative mortality was 4.1% (31 subjects), and patients with troponin-I elevation showed a higher operative mortality rate (RR: 4.23, 95% CI: 2.67-11.31, P < 0.001). In multivariate Cox regression analysis, a troponin-I concentration above 0.10 ng/mL was associated with all-cause mortality (RR: 1.73, 95% CI: 1.27-2.36, P < 0.001). It should be noted that there was a significant difference between patients with elevated and non-elevated troponin-I in the rate of mortality until 6 months. However, these differences disappeared after 6 months. An elevated troponin-I level conferred an increase in mortality during the 7 year follow-up period after major noncardiac surgery. This difference in mortality was mainly derived from the result within the first 6 months. (Int Heart J 2016; 57: 278-284) Key words: Myocardial ischemia, Death, Surgical procedures A ll surgical procedures elicit a stress response, although the extent of the response depends on the extent of the surgery and the use of anesthetics and analgesics that are used to reduce the response. The stress response can lead to increases in heart rate and blood pressure, which can precipitate episodes of myocardial ischemia. 1)Individuals with intermediate to high cardiac risk for noncardiac surgery suffer from perioperative myocardial ischemic injury.2) Cardiac troponins are a useful tool that help clinicians in making the diagnosis of perioperative myocardial infarction.3-5) Many previous studies have investigated the role of cardiac troponins in the diagnosis of perioperative myocardial ischemic events and demonstrated the prognostic value of postoperative cardiac troponin elevation.6-9) A recent metaanalysis of studies in predominantly high-risk surgery patients also showed that cardiac troponin elevation was a strong independent predictor of mortality within the first year after surgery. 10) Editorial p.265The development of perioperative cardiovascular complications not only affects the short-term period prognosis but may also influence the long-term consequences. However, few studies have explored the long-term, defined as beyond the first year after major noncardiac surgery, prognostic value of cardiac troponin elevation in the prediction of postoperative outcome. We undertook this study to evaluate the clinical outcome of cardiac troponin elevation after major noncardiac sur...

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“…No diagnóstico diferencial da hipotensão arterial deve-se lembrar de bloqueio simpático em caso de anestesia subaracnóidea ou peridural, alergia ao contraste e uso de fármacos ou agentes vasodilatadores. O risco de infarto do miocárdio intra-operatório e pós-operatório 50 , bem como de acidente vascular encefálico, está presente e não pode ser menosprezado. Os acidentes vasculares encefálicos são predominantemente isquêmicos ou embólicos, sendo a aterosclerose aórtica um fator independente de risco para essa grave complicação 51,52 .…”

Section: Complicaçõesunclassified

“…The differential diagnosis of hypotension includes sympathetic blockade, in cases of subarachnoid or epidural blocks, allergy to the contrast medium, and use of vasodilators. The intra-and postoperative risk of myocardial infarction 50 as well as strokes cannot be ignored. Strokes are predominantly ischemic or embolic, and aortic atherosclerotic is an independent risk factor for this severe complication 51,52, .…”

Section: Complicationsmentioning

confidence: 99%

Anestesia para intervenção cirúrgica endovascular na aorta abdominal

Lorentz

Boni

Soares

2008

Rev. Bras. Anestesiol.

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Rev Bras AnestesiolARTIGO DE REVISÃO 2008; 58: 5: 520-532 REVIEW ARTICLE RESUMO Lorentz MN, Boni CLA, Soares RR -Anestesia para Intervenção Cirúrgica Endovascular na Aorta Abdominal. JUSTIFICATIVA E OBJETIVOS:O procedimento endovascular para correção de aneurisma de aorta é menos invasivo que o convencional, além de apresentar outras vantagens, como ausência de incisão abdominal, ausência de pinçamento da aorta e menor tempo de recuperação pós-operatória. Por se tratar de procedimento cirúrgico relativamente novo e apresentar uma série de alterações que devem ser conhecidas pelo anestesiologista foi realizado este trabalho com o objetivo de revisar os aspectos mais relevantes do procedimento endovascular e possibilitar manuseio anestésico mais adequado no perioperatório. CONTEÚDO:Apresentação sucinta da técnica cirúrgica para reparo de aneurismas via endovascular, as possíveis vantagens e desvantagens do procedimento, bem como as complicações potenciais. Além disso, foram abordados os cuidados perioperatórios que o procedimento exige e as técnicas anestésicas que podem ser utilizadas. CONCLUSÕES:O conhecimento das alterações provenientes do procedimento endovascular possibilita conduta anestésica mais adequada e melhora dos resultados perioperatórios nesses pacientes.Unitermos: CIRURGIA, Vascular; DOENÇA, Vascular: aneurisma. SUMMARYLorentz MN, Boni CLA, Soares RR -Anesthesia for Endovascular Surgery of the Abdominal Aorta. BACKGROUND AND OBJECTIVES:Endovascular surgery for aneurism of the aorta is less invasive than the conventional procedure besides other advantages such as the absence of abdominal incision, absence of ligature of the aorta, and reduced postoperative recovery time. Since it is a relatively new procedure and to presenting a series of changes that should be known by the anesthesiologist, the objective of this report was to review the most relevant aspects of endovascular surgery, allowing more adequate perioperative anesthetic management. CONTENTS:A brief description of the technique of endovascular aneurism repair, possible vantages and disadvantages of its use, as well as potential complications are discussed. CONCLUSIONS:Knowledge of the changes secondary to the endovascular procedure allows a more adequate anesthetic conduct and improves the postoperative results in those patients.

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Early and Delayed Myocardial Infarction after Abdominal Aortic Surgery

Cited by 203 publications

References 30 publications

Dexmedetomidine and cardiac protection for non‐cardiac surgery: a meta‐analysis of randomised controlled trials

Dexmedetomidine and cardiac protection for non‐cardiac surgery: a meta‐analysis of randomised controlled trials

Troponin-I Level After Major Noncardiac Surgery and Its Association With Long-Term Mortality

Anestesia para intervenção cirúrgica endovascular na aorta abdominal

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