Prediction and early diagnosis of acute myocardial ischemia during anesthesia: a critical review.
Adequate myocardial oxygenation is the result of a good balance between the myocardial oxygen supply and the oxygen demand. Recognition of an insufficient myocardial oxygenation is particularly difficult during general anesthesia because angina pectoris, one of the most reliable indicators of ischemia cannot be expressed. Therefore other indices must be used. Considerable interest but also controversy surrounds the question which routinely monitored determinant of myocardial oxygen supply and demand best predicts and diagnoses beginning myocardial ischemia. A thorough understanding of the sensitivity and the limitations of the different monitoring techniques is a must for every anesthetist dealing with patients with coronary artery disease. The present state of knowledge and the new trends appearing on this subject are reviewed.
De Hert
S G
SG
Department of Anesthesiology, University Hospital Antwerp, Edegem.
Adriaensen
H F
HF
D000768:Anesthesia, General; D003327:Coronary Disease / Q000175:diagnosis*; D006439:Hemodynamics; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis*; D012307:Risk Factors