Perioperative myocardial ischemia is the single most important, potentially reversible risk factor for mortality and cardiovascular complications during and after noncardiac surgery. The influence of anesthetic choices and techniques on cardiac risk in noncardiac surgery is difficult to ascertain because of the low incidence of morbid cardiac outcomes in the surgical population as a whole. This article summarizes several areas (eg, perioperative βblockade, glucose management, and perioperative hemodynamics) that have been addressed in well-designed clinical trials.
Mangano DT, Layug EL, Wallace A., et al. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. N Engl J Med.1996 ;335:1713-1720.
2.
Lindenauer PK , Pekow P., Wang K., et al. Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med.2005;353:349-361.
3.
Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2006 guideline update on perioperative cardiovascular evaluation for noncardiac surgery: focused update on perioperative beta-blocker therapy. Circulation.2006;113: 2662-2675.
4.
Yeager MP, Glass DD, Neff RK, et al. Epidural anesthesia and analgesia in high-risk surgical patients . Anesthesiology. 1987;66:729-736.
5.
Tuman KJ, McCarthy RJ, March RJ, et al. Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesth Analg.1991; 73:696-704.
6.
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.
7.
Christopherson R., Beattie C., Frank SA, et al. Perioperative morbidity in patients randomized to epidural or general anesthesia for lower extremity vascular surgery: Perioperative Ischemia Randomized Anesthesia Trial Study Group. Anesthesiology. 1993;79:422-434.
8.
Bode RH, Lewis KP, Zarich SW, et al. Cardiac outcome after peripheral vascular surgery: comparison of general and regional anesthesia. Anesthesiology. 1996;84:3-13.
9.
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.
10.
Park WY, Thompson JS, Lee KKEffect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled Veterans Affairs cooperative study. Ann Surg.2001;234:560-571.
11.
Urwin SC, Parker MJ, Griffiths R.General versus regional anaesthesia for hip fracture surgery: a meta-analysis of randomized trials. Br J Anaesth.2000;84;450-455.
12.
Tangkanakul C., Counsell CE, Warlow CPLocal versus general anaesthesia in carotid endarterectomy: a systematic review of the evidence. Eur J Endovasc Surg.1997;13:491-499.
13.
Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: a randomized clinical trial. JAMA.1997;277:1127-1134.
14.
Melling A., Ali B., Scott EM, et al. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial. Lancet . 2001; 358:876-880.
15.
Wong PF, Kumar S., Bohra A., et al. Randomized clinical trial of perioperative systemic warming in major elective abdominal surgery. Br J Surg.2007;94:421-426.
16.
Van den Berghe G., Wouters P., Weekers F., et al. Intensive insulin therapy in the critically ill patients. N Engl J Med.2001;345:1359-1367.
17.
Furnary AP, Wu Y., Bookin SOEffect of hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures: the Portland Diabetic Project. Endocr Pract. 2004;10(suppl 2):21-33.
18.
Gandhi GY, Nuttall GA, Abel MD, et al. Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial. Ann Intern Med.2007;146:233-243.
19.
Rao TL, Jacobs KH, EL-Etr AA. Reinfarction following anesthesia in patients with myocardial infarction . Anesthesiology. 1983;59:499-505.
20.
Goldman L., Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med.1977;297:845-850.
21.
Charlson ME , MacKenzie CR, Gold JP, et al. Preoperative characteristics predicting intraoperative hypotension and hypertension among hypertensives and diabetics undergoing noncardiac surgery. Ann Surg.1990 ;212:66-81.
22.
Mauney FM Jr, Ebert PA, Sabiston DC Jr.Postoperative myocardial infarction: a study of predisposing factors, diagnosis and mortality in a high risk group of surgical patients. Ann Surg.1970;172:497-503.
23.
Reich DL, Bennerr-Guerrero E., Bodian CA, et al. Intraoperative tachycardia and hypertension are independently associated with adverse outcome in noncardiac surgery of long duration. Anesth Analg.2002;95:273-277.
24.
Reich DL, Bodian CA, Krol M., et al. Intraoperative hemodynamic predictors of mortality, stroke, and myocardial infarction after coronary artery bypass surgery. Anesth Analg.1999;89:814-822.
25.
Reich DL, Bennett-Guerrero E., Bodian CA, et al. Intraoperative tachycardia and hypertension are independently associated with adverse outcome in noncardiac surgery of long duration. Anesth Analg.2002;95: 273-277.
26.
Reich DL, Wood RK Jr, Emre S., et al. Association of intraoperative hypotension and pulmonary hypertension with adverse outcomes after orthotopic liver transplantation. J Cardiothorac Vasc Anesth.2003;17:699-702.
27.
Reich DL, Hossain S., Krol M., et al. Predictors of hypotension after induction of general anesthesia . Anesth Analg.2005;101:622-628.
28.
Benson M., Junger A., Fuchs C., et al. Use of an Anesthesia Information Management System (AIMS) to evaluate the physiologic effects of hypnotic agents used to induce anesthesia . J Clin Monit Comput.2000;16:183-190.
29.
Klasen J., Junger A.Hartmann B., et al. Differing incidences of relevant hypotension with combined spinal-epidural anesthesia and spinal anesthesia. Anesth Analg.2003;96:1491-1495.
