[Multicenter study of cardiac events and anesthetic management of patients with ischemic heart diseases undergoing noncardiac surgery].
We designed a joint research project to investigate the incidence of ischemic heart diseases in patients undergoing noncardiac surgery and to define the risk of perioperative cardiac complications in these patients. Of the 8358 surgical patients in the 8 departments of anesthesiology between March 1997 and June 1997, 328 (3.9%) had ischemic heart diseases. Among the 328 patients, 54 (16.4%) developed perioperative cardiac events, including myocardial infarction (3 patients) and either lethal or potentially dangerous dysrhythmias (51 patients). Preoperative cardiac assessments were performed while the anesthetic techniques including intensive monitoring and perioperative prophylactic therapy were also employed. Patients with ischemic heart diseases received various types of preoperative evaluation to identify the degree of coronary artery disease and to assess the overall cardiac function. The patients were monitored using a multilead electrocardiogram, an arterial line, a central venous catheter, a pulmonary artery catheter, and by transesophageal echocardiography intraoperatively. Therapeutically, isosorbide, nitroglycerin, beta-blockers, calcium channel blockers, and/or nicorandil were administered to prevent perioperative ischemia. So far, no generally accepted management strategies have been established in patients with cardiovascular disorders based on large-scale outcome trials in Japan. Therefore, nationwide large multicenter trials are awaited with interest in order to establish helpful guidelines to improve the perioperative management and to reduce ischemia in cardiac patients undergoing noncardiac surgery.
Yamada
T
T
Department of Anesthesiology, Keio University, School of Medicine, Tokyo.
Nomura
M
M
Iwade
M
M
Omi
A
A
Kashimoto
S
S
Yoshioka
H
H
Kikuchi
T
T
Fujimoto
K
K
Honda
O
O
Seki
M
M
Ishiguro
T
T
Takeda
J
J
D000758:Anesthesia; D002317:Cardiovascular Agents / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D016343:Monitoring, Intraoperative; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000517:prevention & control; D017202:Myocardial Ischemia / Q000453:epidemiology*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D017410:Practice Guidelines as Topic / Q000592:standards; D012306:Risk
D002317:Cardiovascular Agents