Preoperative Silent Myocardial Ischaemia: Incidence and Predictors in a General Surgical Population

Muir, A. D.; Reeder, M.K.; Foëx, P.; Ormerod, Oliver; Sear, J.W.; Johnston, Colin

doi:10.1093/bja/67.4.373

Cited by 28 publications

(8 citation statements)

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“…The intraoperative techniques utilized should permit modulation of sympathetic nervous system responses and prompt control of hemodynamic variables [ 3 ]. The basic challenge during induction and maintenance of anesthesia for patients with ischaemic heart disease is to prevent further myocardial ischaemia.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Management For Surgical Excision Of A Cerebellar Infarct In A Patient With Acute Myocardial Infarction

Mathews¹,

Singh²

2005

IJA

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A forty nine year old male who had sustained acute myocardial infarction two days earlier, experienced respiratory arrest and complete heart block and was admitted with a diagnosis of left cerebellar infarct and obstructive hydrocephalus. On examination he was responding to deep painful stimuli with right hemiparesis. ECG indicated acute inferolateral myocardial infarction. Echocardiogram showed an ejection fraction of 63%. Arterial blood gases revealed severe respiratory alkalosis and arterial desaturation. The lungs were ventilated and inotropic support was started to ensure a stable hemodynamic status. Evacuation of the cerebellar infarct was planned as an emergency procedure. Anesthesia was maintained using N 2 O -O 2 -narcoticneuromuscular blocking drugs sequence. Continuous monitoring of ECG, ST segment, invasive arterial blood pressure, CVP, ETCO 2 , SaO 2 and temperature were instituted. The intraoperative period was uneventful. Elective postoperative ventilation was continued for three days. He was then transferred to the step down intermediate care unit for definitive therapy.

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Section: Discussionmentioning

confidence: 99%

Anesthetic Management For Surgical Excision Of A Cerebellar Infarct In A Patient With Acute Myocardial Infarction

Mathews¹,

Singh²

2005

IJA

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“…We have previously published data showing a greater incidence of preoperative silent myocardial ischemia (SMI) in hypertensive compared with normotensive patients; and in untreated and poorly treated hypertensive patients (blood pressure < 160/90 mm Hg) compared with normotensive patients or well-treated hypertensive patients [29,30]. Different intercurrent treatments appear to have no effect on the occurrence of preoperative SMI in these at-risk patients.…”

Section: Cardiac Ischemia and Biomarkersmentioning

confidence: 99%

Perioperative control of hypertension: When will it adversely affect perioperative outcome?

Sear

2008

Current Science Inc

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Much has been published about the impact of treatment on adverse outcomes in patients with cardiovascular diseases. Hypertension is an extremely common condition affecting a significant percentage of the world population. Although care guidelines exist for the medical patient with raised blood pressure, there are no accepted guidelines for the preoperative evaluation and perioperative care of the patient with hypertension who undergoes noncardiac surgery. Of particular importance are defining at-risk groups of patients, and the indications for cancellation to treat and hence reduce this risk. This review examines the interactions between hypertension, drug therapies, anesthesia, and adverse outcomes in these patients. Recommendations for identifying patients at greatest risk of adverse cardiovascular events and cardiac mortality have been developed through evaluation of available data. Based on these findings, the only patients in whom cancellation may be justified and the level of hypertension treated prior to surgery are those with stage 2 hypertension and accompanying target-organ damage, or stage 3 hypertension (blood pressure > 180/> 110 mm Hg).

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“…Myocardial ischaemia has been detected in lead V 5 of the ECG in patients with a history of hypertension undergoing general anaesthesia. These transient episodes were associated with tachycardia and noxious stimuli, such as laryngoscopy and intubation 2,[37][38][39] . In 325 elective non-cardiac surgical patients who underwent ambulatory ECG monitoring preoperatively, hypertension despite long-term maintenance treatment was associated with the presence of silent myocardial ischaemia 40 .…”

Section: Anaesthesia and Hypertensionmentioning

confidence: 99%

Anaesthesia and Isolated Systolic Hypertension— Pathophysiology and Anaesthesia Risk

Wongprasartsuk

Sear

2003

Anaesth Intensive Care

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This review examines the pathophysiology of isolated systolic hypertension, changing medical perspectives on this condition as a cardiovascular risk factor in the community and evolving evidence of it being an independent risk factor for perioperative morbidity and mortality.Hypertension is regarded as an added risk in anaesthesia. Continuation of antihypertensive medication through the perioperative period is an established principle. Studies supporting this practice have demonstrated greater perioperative haemodynamic stability in association with general anaesthesia and surgery in patients with treated hypertension compared to untreated hypertension. Therapy has historically focused on control of diastolic blood pressure, rather than systolic blood pressure. Recent clinical trial data and data from large observational studies show a closer association of systolic hypertension with both coronary heart disease and stroke compared with diastolic hypertension. This has led to recommendations for aggressive treatment of isolated systolic hypertension, especially in patients over 65 years old.The association between decreased compliance of the central systemic arteries and isolated systolic hypertension is well understood. The fact that this same pathology, lack of compliance of central arteries, can cause a decrease in diastolic blood pressure is not so well recognised. This means that, in patients with isolated systolic hypertension, decreasing diastolic blood pressure can be associated with worsening arterial disease and that systolic minus diastolic blood pressure may give a better indication of the problem.Anaesthetic assessment and technique should be studied and potentially revised in the light of these changes in perspective on isolated systolic hypertension.

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Preoperative Silent Myocardial Ischaemia: Incidence and Predictors in a General Surgical Population

Cited by 28 publications

References 0 publications

Anesthetic Management For Surgical Excision Of A Cerebellar Infarct In A Patient With Acute Myocardial Infarction

Anesthetic Management For Surgical Excision Of A Cerebellar Infarct In A Patient With Acute Myocardial Infarction

Perioperative control of hypertension: When will it adversely affect perioperative outcome?

Anaesthesia and Isolated Systolic Hypertension— Pathophysiology and Anaesthesia Risk

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