The influence of anesthetic choices and techniques upon outcomes in cardiac surgery is difficult to ascertain because of the low incidence of morbid and fatal outcomes that are attributable to anesthetic management. This discussion summarizes several areas that have been addressed in clinical trials, including temperature management, intraoperative hemodynamics, and glucose control.
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References
1.
Frank SM, Fleisher LA, Breslow MJ, et al: Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: A randomized clinical trial. JAMA277:1127-1134, 1997.
2.
Kurz A, Sessler DI, Lenhardt R: Perioperative normothermia to reduce the incidence of surgical wound infection and shorten hospitalization. N Engl J Med334:1209-1215, 1996.
3.
Pryor KO, Fahey TJ 3rd, Lien CA, et al: Surgical site infection and the routine use of perioperative hyperoxia in a general surgical population: A randomized controlled trial. JAMA291:79-87, 2004.
4.
Grigore AM, Grocott HP, Mathew JP, et al: The rewarming rate and increased peak temperature alter neurocognitive outcome after cardiac surgery. Anesth Analg94:4-10, 2002.
5.
Van den Berghe G, Wouters P, Weekers F, et al: Intensive insulin therapy in the critically ill patients. N Engl J Med345:1359-1367, 2001.
6.
Furnary AP, Wu Y, Bookan SO, et al: Effect of hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures. The Portland Diabetic Project. Endocr Pract 10 (Suppl 2):21-33, 2004.
7.
Reich DL, Bodian CA, Krol M, et al: Intraoperative hemodynamic predictors of mortality, stroke, and myocardial infarction after coronary artery bypass grafting. Anesth Analg89:814-822, 1999.
8.
Reich DL, Bennett-Guerrero E, Bodian CA, et al: Intraoperative tachycardia and hypotension are independently associated with adverse outcome in noncardiac surgery of long duration. Anesth Analg95:273-277, 2002.