Anesthetic implications for the management of patients with acute myocardial infarction: a matched cohort study of patients undergoing emergency myocardial revascularization.
Emergency coronary artery bypass grafting (CABG) is advocated as a treatment of acute myocardial infarction (AMI). To attempt to define anesthetic management problems in this patient group, a retrospective study was conducted comparing the perioperative courses of 23 patients undergoing emergency CABG during AMI with 23 elective patients, individually matched for gender, operating surgeon, ejection fraction, and aortic crossclamp time. The 23 AMI patients were anesthetized 5.98 +/- 3.0 (range 1.5 to 11.0) hours after the onset of chest pain. Anesthetic agents were similar for both groups. Induction of anesthesia was well tolerated by AMI patients. Tolerance of cardioplegic arrest was impaired in the AMI group as evidenced by the sharp increase in frequency of inotropic support required to discontinue bypass in the AMI group compared to elective patients (12/23 v 3/23; P less than .005). Fifteen AMI patients who received preoperative streptokinase had greater postoperative bleeding. Three AMI patients died postoperatively. The number of patients requiring prolonged postoperative ventilation and extended ICU care was higher in the AMI group. It is concluded that patients undergoing emergency CABG during AMI represent a greater risk than elective patients. They have a higher incidence of myocardial dysfunction following cardioplegic arrest during bypass. Those who receive preoperative thrombolytic therapy exhibit greater bleeding tendencies.
Hill
R F
RF
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710.
Kates
R A
RA
Davis
D
D
Reves
J G
JG
D000771:Anesthesia, Intravenous; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D004562:Electrocardiography; D004630:Emergencies; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D011182:Postoperative Care; D011300:Preoperative Care; D012189:Retrospective Studies; D013300:Streptokinase / Q000627:therapeutic use
D000889:Anti-Arrhythmia Agents; D002316:Cardiotonic Agents; D013300:Streptokinase