Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-26T22:48:13.121Z Has data issue: false hasContentIssue false
  • English
  • Français

Cardiac risk reduction in non-cardiac surgery: the role of anaesthesia and monitoring techniques

Published online by Cambridge University Press:  24 May 2006

J. Gal ,
L. Bogar ,
G. Acsady  and
M. D. Kertai
J. Gal
Affiliation:
Semmelweis University, Department of Cardiovascular Surgery, Budapest, Hungary
L. Bogar
Affiliation:
University of Pecs School of Medicine, Department of Anaesthesia and Intensive Care, Pecs, Hungary
G. Acsady
Affiliation:
Semmelweis University, Department of Cardiovascular Surgery, Budapest, Hungary
M. D. Kertai
Affiliation:
Semmelweis University, Department of Cardiovascular Surgery, Budapest, Hungary
Get access

Extract

Summary

Cardiac complications are the major cause of perioperative morbidity and mortality of patients undergoing non-cardiac surgery. This is related to the frequent presence of underlying coronary artery disease. In the last few decades, attention has focused on preoperative cardiac risk assessment that may help to identify patients at increased cardiac risk for whom cardioprotective medication and, when indicated, coronary revascularization may improve perioperative outcome. On the other hand, less attention was given to the role of anaesthesia and monitoring techniques in the cardiac risk management of high-risk patients undergoing non-cardiac surgery. The aim of this review was to summarize the current evidence from published studies on the effect of the type of anaesthesia and monitoring techniques on perioperative cardiac outcome in non-cardiac surgery.

Keywords

MORBIDITY, cardiacMORTALITY, cardiacINTRAOPERATIVE PERIODMYOCARDIAL ISCHAEMIAANAESTHETICS INHALATIONALANAESTHESIA, EPIDURALCARDIOVASCULAR PHYSIOLOGY, monitoring
Type
Review
Information
European Journal of Anaesthesiology , Volume 23 , Issue 8 , August 2006 , pp. 641 - 648
Copyright
© 2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Mangano DT. Perioperative cardiac morbidity. Anesthesiology 1990; 72: 153–184.Google Scholar
Lee TH, Marcantonio ER, Mangione CM et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major non-cardiac surgery. Circulation 1999; 100: 1043–1049.Google Scholar
Roy WL, Edelist G, Gilbert B. Myocardial ischemia during non-cardiac surgical procedures in patients with coronary-artery disease. Anesthesiology 1979; 51: 393–397.Google Scholar
Lieberman RW, Orkin FK, Jobes DR, Schwartz AJ. Hemodynamic predictors of myocardial ischemia during halothane anesthesia for coronary-artery revascularization. Anesthesiology 1983; 59: 36–41.Google Scholar
Isaacson IJ, Lowdon JD, Berry AJ et al. The value of pulmonary artery and central venous monitoring in patients undergoing abdominal aortic reconstructive surgery: a comparative study of two selected, randomized groups. J Vasc Surg 1990; 12: 754–760.Google Scholar
Valentine RJ, Duke ML, Inman MH et al. Effectiveness of pulmonary artery catheters in aortic surgery: a randomized trial. J Vasc Surg 1998; 27: 203–211.Google Scholar
Wilson J, Woods I, Fawcett J et al. Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery. BMJ 1999; 318: 1099–1103.Google Scholar
Dawood MM, Gutpa DK, Southern J, Walia A, Atkinson JB, Eagle KA. Pathology of fatal perioperative myocardial infarction: implications regarding pathophysiology and prevention. Int J Cardiol 1996; 57: 37–44.Google Scholar
Cohen MC, Aretz TH. Histological Analysis of coronary artery lesions in fatal postoperative myocardial infarction. Cardiovasc Pathol 1999; 8: 133–139.Google Scholar
Priebe HJ. Perioperative myocardial infarction – aetiology and prevention. Br J Anaesth 2005; 95: 3–19.Google Scholar
Warltier DC, Pagel PS, Kersten JR. Approaches to the prevention of perioperative myocardial ischemia. Anesthesiology 2000; 92: 253–259.Google Scholar
Warltier DC, Al Wathigui MH, Kampine JP, Schmeling WT. Recovery of contractile function of stunned myocardium in chronically intsrumented dogs is enhanced by halothane or isoflurane. Anesthesiology 1988; 69: 552–565.Google Scholar
Davis RF, DeBoer LW, Rude RE, Lowenstein E, Maroko PR. The effect of halothane anesthesia on myocardial necrosis, hemodynamic performance, and regional myocardial blood flow in dogs following coronary artery occlusion. Anesthesiology 1983; 59: 402–411.Google Scholar
Cope DK, Impastato WK, Cohen MV, Downey JM. Volatile anesthetics protect the ischemic rabbit myocardium from infarction. Anesthesiology 1997; 86: 699–709.Google Scholar
Novalija E, Fujita S, Kampine JP, Stowe DF. Sevoflurane mimics ischemic preconditioning effects on coronary flow and nitric oxide release in isolated hearts. Anesthesiology 1999; 91: 701–712.Google Scholar
Zaugg M, Lucchinetti E, Spahn DR, Pasch T, Schaub MC. Volatile anesthetics mimic cardiac preconditioning by priming the activation of mitochondrial KATP channels via multiple signaling pathways. Anesthesiology 2002; 97: 4–14.Google Scholar
Siegmund B, Schlack W, Ladilov YV, Balser C, Piper HM. Halothane protects cardiomyocytes against reoxygenation induced hypercontracture. Circulation 1997; 96: 4372–4379.Google Scholar
Kowalski C, Zahler S, Becker BF et al. Halothane, isoflurane, and sevoflurane reduce postischemic adhesion of neutrophils in the coronary system. Anesthesiology 1997; 86: 188–195.Google Scholar
Heindl B, Becker BF, Zahler S, Conzen PF. Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts. Acta Anaesthesiol Scand 1998; 42: 995–1003.Google Scholar
De Hert SG, van der Linden PJ, Cromheecke S et al. Cardioprotective properties of sevoflurane in patients undergoing coronary surgery with cardiopulmonary bypass are related to the modalities of its administration. Anesthesiology 2004; 101: 299–310.Google Scholar
Schlack W, Hollmann M, Stunneck J, Thamer V. Effect of halothane on myocardial reoxygenation injury in the isolated rat heart. Br J Anaesth 1996; 76: 860–867.Google Scholar
Weber NC, Preckel B, Schlack W. The effect of anaesthetics on the myocardium – new insights into myocardium protection. Eur J Anaesthesiol 2005; 22: 647–657.Google Scholar
Reiz S, Ostman M. Regional coronary hemodynamics during isoflurane–nitrous oxide anesthesia in patients with ischemic heart disease. Anesth Analg 1985; 64: 570–576.Google Scholar
Khambatta HJ, Sonntag H, Larsen R et al. Global and regional myocardial blood flow and metabolism during equipotent halothane and isoflurane anesthesia in patients with coronary artery disease. Anesth Analg 1988; 67: 936–942.Google Scholar
Hohner P, Nancarrow C, Backman C et al. Anaesthesia for abdominal vascular surgery in patients with coronary artery disease (CAD). Part I. Isoflurane produces dose-dependent coronary vasodilation. Acta Anaesthesiol Scand 1994; 38: 780–792.Google Scholar
Forrest JB, Cahalan MK, Rehder K et al. Multicenter study of general anesthesia. II. Results. Anesthesiology 1990; 72: 262–268.Google Scholar
Forrest JB, Rehder K, Cahalan MK, Goldsmith CH. Muticenter study of general anesthesia. III. Predictors of severe perioperative adverse outcomes. Anesthesiology 1992; 76: 3–15. Erratum in: Anesthesiology 1992; 77: 222.Google Scholar
Rooke GA, Ebert TJ, Muzi M, Kharasch ED. The hemodynamic and renal effects of sevoflurane and isoflurane in patients with coronary artery disease and chronic hypertension. Anesth Analg 1996; 82: 1159–1165.Google Scholar
Ebert TJ, Kharasch ED, Rooke GA, Shroff A, Muzi M. Myocardial ischemia and adverse cardiac outcomes in cardiac patients undergoing non-cardiac surgery with sevoflurane and isoflurane. Anesth Analg 1997; 85: 993–999.Google Scholar
Ebert TJ, Harkin CP, Muzi M. Cardiovascular responses to sevoflurane: a review. Anesth Analg 1995; 81: S11–S22.Google Scholar
Frink EJJ, Malan TP, Atlas M et al. Clinical comparison of sevoflurane and isoflurane in healthy patients. Anesth Analg 1992; 74: 241–245.Google Scholar
Larach DR, Schuler HG. Direct vasodilation by sevoflurane, isoflurane, and halothane alters coronary flow reserve in the isolated rat heart. Anesthesiology 1991; 75: 268–278.Google Scholar
Rigg JR. Does regional block improve outcome after surgery? Anaesth Intensive Care 1991; 19: 404–411.Google Scholar
Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology 1995; 82: 1474–1506.Google Scholar
Garnett RL, MacIntyre A, Lindsay P et al. Perioperative ischaemia in aortic surgery: combined epidural/general anaesthesia and epidural analgesia vs general anaesthesia and i.v. analgesia. Can J Anaesth 1996; 43: 769–777.Google Scholar
Baron JF, Bertrand M, Barre E et al. Combined epidural and general anesthesia versus general anesthesia for abdominal aortic surgery. Anesthesiology 1991; 75: 611–618.Google Scholar
Norris EJ, Beattie C, Perler BA et al. Double-masked randomized trial comparing alternate combinations of intraoperative anesthesia and postoperative analgesia in abdominal aortic surgery. Anesthesiology 2001; 95: 1054–1067.Google Scholar
Bois S, Couture P, Boudreault D et al. Epidural analgesia and intravenous patient-controlled analgesia result in similar rates of postoperative myocardial ischemia after aortic surgery. Anesth Analg 1997; 85: 1233–1239.Google Scholar
Boylan JF, Katz J, Kavanagh BP et al. Epidural bupivacaine-morphine analgesia versus patient-controlled analgesia following abdominal aortic surgery: analgesic, respiratory, and myocardial effects. Anesthesiology 1998; 89: 585–593.Google Scholar
O'Hara DA, Duff A, Berlin JA et al. The effect of anesthetic technique on postoperative outcomes in hip fracture repair. Anesthesiology 2000; 92: 928–930.Google Scholar
Rodgers A, Walker N, Schug S et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000; 321: 1493–1505.Google Scholar
Beattie WS, Badner NH, Choi P. Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg 2001; 93: 853–858.Google Scholar
Park WY, Thompson JS, Lee KK. Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled Veterans Affairs cooperative study. Ann Surg 2001; 234: 560–569.Google Scholar
Rigg JR, Jamrozik K, Myles PS et al. Design of the multicenter Australian study of epidural anesthesia and analgesia in major surgery: the MASTER trial. Control Clin Trials 2000; 21: 244–256.Google Scholar
Swan HJC, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D. Catheterization of the heart in man with the use of a flow-directed balloon-tipped catheter. New Engl J Med 1970; 283: 447–451.Google Scholar
Cooper AB, Doig GS, Sibbald WJ. Pulmonary artery catheters in the critically ill: an overview using the methodology of evidence-based medicine. Crit Care Clin 1996; 12: 777–794.Google Scholar
Sandham JD, Hull RD, Brant RF et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. New Engl J Med 2003; 348: 5–14.Google Scholar
Harvey S, Harrison DA, Singer M et al. Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomized controlled trial. Lancet 2005; 366: 472–477.Google Scholar
Kaplan JA, King SBI. The precordial electrocardiographic lead (V5) in patients who have coronary-artery disease. Anesthesiology 1976; 45: 570–574.Google Scholar
Konstadt S, Goldman M, Thys D, Mindich BP, Kaplan JA. Intraoperative diagnosis of myocardial ichemia. Mt Sinai J Med 1985; 52: 521–525.Google Scholar
Ellis JE, Shah MN, Briller JE, Roizen MF, Aronson S, Feinstein SB. A comparison of methods for the detection of myocardial ischemia during non-cardiac surgery: automated ST-segment analysis systems, electrocardiography, and transesophageal echocardiography. Anesth Analg 1992; 75: 764–772.Google Scholar
Haggmark S, Hohner P, Ostman M et al. Comparison of hemodynamic, electrocardiographic, mechanical, and metabolic indicators of intraoperative myocardial ischemia in vascular surgical patients with coronary artery disease. Anesthesiology 1989; 70: 19–25.Google Scholar
Hauser AM, Gangadharan V, Ramos RG, Gordon S, Timmis GC. Sequence of mechanical, electrocardiographic and clinical effects of repeated coronary artery occlusion in human beings: echocardiographic observations during coronary angioplasty. J Am Coll Cardiol 1985; 5: 193–197.Google Scholar
London MJ, Tubau JF, Wong MG et al. The ‘natural history’ of segmental wall motion abnormalities in patients undergoing non-cardiac surgery. S.P.I. Research Group. Anesthesiology 1990; 73: 644–655.Google Scholar
Smith JS, Cahalan MK, Benefiel DJ et al. Intraoperative detection of myocardial ischemia in high-risk patients: electrocardiography versus two-dimensional transesophageal echocardiography. Circulation 1985; 72: 1015–1021.Google Scholar
Eisenberg MJ, London MJ, Leung JM et al. Monitoring for myocardial ischemia during non-cardiac surgery. A technology assessment of transesophageal echocardiography and 12-lead electrocardiography. The Study of Perioperative Ischemia Research Group [see comments]. JAMA 1992; 268: 210–216.Google Scholar
Buhre W, Weyland A, Kazmaier S et al. Comparison of cardiac output assessed by pulse-contour analysis and thermodilution in patients undergoing minimally invasive direct coronary artery bypass grafting. J Cardiothorac Vasc Anesth 1999; 13: 437–440.Google Scholar
Buhre W, Rossaint PR. Perioperative management and monitoring in anaesthesia. The Lancet 2003; 362: 1839–1846.Google Scholar
Buhre W, Weyland A, Schorn B et al. Assessment of cardiac preload by indicator dilution and transoesophageal echocardiography. Eur J Anaesthesiol 2001; 18: 662–667.Google Scholar
Sakka SG, Bredle DL, Reinhart K, Meier-Hellmann A. Comparison between intrathoracic blood volume and cardiac filling pressures in the early phase of hemodynamic instability of patients with sepsis or septic shock. J Crit Care 1999; 14: 78–83.Google Scholar