Perioperative Myocardial Ischemia in the Noncardiac Surgical Patient

Fegert, G; Hollenberg, Milton; Browner, W.; Wellington, Yuriko C.; Levenson, Linda; Franks, Maria; Harris, D.; Mangano, Dennis T.

doi:10.1097/00000542-198809010-00049

Cited by 25 publications

(5 citation statements)

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“…The same was also proved in a study by Fegert et al [11] Cardiac enzymes were not estimated in this study. Some of the non specific ST-T segment changes may occur due to changes in the body temperature, serum electrolytes, ventilatory patterns or the influence of drugs [11]. Many of these patients were on beta blockers in the pre-operative period and the same were continued post-operatively.…”

Section: Discussionsupporting

confidence: 90%

Incidence of post-operative cardiac complications in cardiac patients undergoing urological procedures

Shaik¹,

M²,

Sailaja³

2015

Int J of Adv in Sci Res

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Context: There are limited studies indicating the incidence of post operative morbidity and mortality in high risk patients. Urological procedures constitute a major portion of geriatric surgeries where a cardiac complication is almost inevitable and therefore this group was selected for this study purpose. Aims: To compare the incidence of post operative cardiovascular complications during regional and general anesthetic techniques in patients with known cardiac risk undergoing urological surgeries. Settings and Design: Prospective randomized double blind study. Methods and Material; 40 patients aged above 50 years posted for elective urological surgeries were enrolled in the study after obtaining approval from hospital ethics committee and written informed consent from the patients. Patients were divided into two groups A& B. Group A (n=20) received general and group B (n=20) received regional anaesthesia (spinal/ Epidural). All the patients received standard premedication and their basal vitals (BP, HR, ECG pattern) were recorded. The same parameters were monitored in the post operative period at regular intervals. Statistical analysis used: Student "t" test was used to test the significance of statistical difference in the variables between the two groups. Results: The mean heart rate and the mean arterial blood pressure were increased (P<0.01) in the general anaesthesia group. Group A showed 10% incidence of ECG changes and group B showed 35% incidence of ECG changes. But the changes in the hemodynamics were not significant. Conclusions: There is no difference between regional anaesthesia and general anaesthesia regarding the post operative outcome after urological procedures with respect to hemodynamic changes.

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Section: Discussionsupporting

confidence: 90%

Incidence of post-operative cardiac complications in cardiac patients undergoing urological procedures

Shaik¹,

M²,

Sailaja³

2015

Int J of Adv in Sci Res

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“…Overall, anaesthesia and surgery did not worsen preoperative ischaemia significantly. Similar observations have been made in previous studies, involving patients undergoing coronary artery bypass grafting (CABG) [12], or non-cardiac surgery [13]. However, patients with treated hypertension, with or without other cardiovascular disease, became significantly more ischaemic after operation.…”

Section: Discussionsupporting

confidence: 87%

“…Ischaemic events occurred in 81 % of our patients before operation, and this reflects our selection of an at-risk group. The rate was 18-40% in other studies using continuous ECG monitoring [12][13][14]. Some of these studies were based on patients about to have cardiac surgery, and as our criteria for an ischaemic event were similar, the greater incidence in our patients may be a reflection of differences in patient selection.…”

Section: Discussionmentioning

confidence: 85%

Continuous Ambulatory Ecg Monitoring in the Perioperative Period: Relationship of Preoperative Status and Outcome

McHugh

Gill

Wyld

et al. 1991

British Journal of Anaesthesia

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We have used continuous ambulatory electrocardiography in the perioperative period to monitor 108 patients with known cardiovascular disease undergoing non-cardiac surgery. There was a high incidence of ischaemic ST segment changes and ventricular arrhythmias. For the group as a whole, anaesthesia and surgery were followed by increased ventricular ectopic activity, but did not worsen myocardial ischaemia. However, the mean duration of ischaemic ST segment changes was increased significantly in those patients with treated hypertension. Of the risk factors considered, preoperative ischaemia and peroperative systolic arterial pressure were significant correlates with postoperative myocardial ischaemia.

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“…The reports of many authors have shown similar findings [51-53, 77, 78]. The multifactorial cardiac risk index published in 1977 by GOLDMAN et al [50] has since been confirmed by many other reports [79][80][81][82][83][84][85][86]. One of Goldman's risk factors for an operation was a myocardial infarction within the previous 6 months.…”

Section: Cardiac Riskmentioning

confidence: 66%

Functional evaluation of the lung resection candidate

Bolliger¹,

Perruchoud²

1998

Eur Respir J

163

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Advances in operative technique and perioperative care have considerably reduced surgical morbidity and mortality after pulmonary resections. Various single and combined parameters of functional operability have been proposed to assess the surgical risk. Pulmonary function tests adequately assess the pulmonary risk, and baseline or stress electrocardiography, echocardiography and nuclear cardiac studies assess the cardiac risk.Patients with normal or only slightly impaired pulmonary function (forced expiratory volume in one second (FEV1) and transfer factor of the lung for carbon monoxide (TL,CO) ≥80% of predicted) and no cardiovascular risk factors can undergo pulmonary resections up to a pneumonectomy without further investigation. For others, exercise testing, pulmonary split-function studies, or a combination of these two methods are recommended. Exercise testing, most frequently performed as a symptom-limited test with the measurement of maximal oxygen uptake (V 'O 2 ,max), assesses both the pulmonary and cardiovascular reserves. A V'O 2 ,max of <10 mL·kg -1 ·min -1 is generally considered prohibitive for any resection, a value of >20 mL·kg -1 ·min -1 or >75% of predicted normal, safe for major resections. Split-function studies are radionuclide-based estimations of the predicted postoperative (ppo) values of various parameters. The currently used ppo-parameters are FEV1-ppo, TL,CO-ppo and, most recently, V'O 2 ,max-ppo. Suggested cutoff values for safe resection are: for FEV1-ppo and TL,CO-ppo ≥40% pred; and for V 'O 2 ,max ≥35% pred, combined with an absolute value of ≥10 mL·kg -1 ·min -1 . The lowest acceptable ppo-values will still have to be established by additional prospective studies.In the long-term, resections involving not more than one lobe usually lead to an early functional deficit followed by later recovery. The permanent functional loss in pulmonary function is small (≤10%) and exercise capacity is only slightly reduced or not at all. Pneumonectomy, on the other hand, leads to an early permanent loss of about 33% in pulmonary function and 20% in exercise capacity. Thus, pulmonary function tests alone overestimate the functional loss after lung resection. Eur Respir J 1998; 11: 198-212 The dramatic increase in the incidence of bronchogenic carcinoma has made this disease the most frequent malignancy worldwide. In industrialized nations, the majority of lung resection candidates suffer from bronchogenic carcinoma, whereas only some decades ago benign conditions, such as destroyed lung parenchyma after tuberculosis, had to be removed. The prognosis of bronchogenic carcinoma remains sombre as about 75-85% are inoperable at the time of diagnosis [1], and despite recent advances in chemo-and radiotherapy regimens, surgical resection remains the only curative form of treatment [2].Depending on their extent, pulmonary resections lead to permanent loss of pulmonary function. In healthy people, resections up to a pneumonectomy are tolerated remarkably well. Lung cancer patients, however, are...

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Perioperative Myocardial Ischemia in the Noncardiac Surgical Patient

Cited by 25 publications

References 0 publications

Incidence of post-operative cardiac complications in cardiac patients undergoing urological procedures

Incidence of post-operative cardiac complications in cardiac patients undergoing urological procedures

Continuous Ambulatory Ecg Monitoring in the Perioperative Period: Relationship of Preoperative Status and Outcome

Functional evaluation of the lung resection candidate

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