Abstract：
STUDY OBJECTIVE:To assess the impact of intraoperative hemodynamics in the development of perioperative myocardial infarction (MI) and myocardial ischemia after noncardiac surgery. DESIGN:Single-center retrospective cohort study of surgical patients from 2007 to 2012. SETTING:Postanesthesia care unit, intensive care unit, and medical-surgical ward at an academic tertiary medical center. PATIENTS:A total of 46,799 adult noncardiac, nonthoracic surgery patients, for which 2290 peak cardiac troponin (cTn) levels were available. MEASUREMENTS:The 10-point Surgical Apgar Score (SAS) was calculated from intraoperative heart rate, blood pressure, and blood loss. Peak troponin (cTn) levels, hospital length of stay, 7- and 30-day postoperative mortality, patient demographics, and prior medical conditions were gathered. Troponin leak was defined as cTn-I 0.6 to 1.5 ng/mL or cTn-T 0.1 to 0.3 ng/mL; perioperative MI criteria were cTn-I greater than 1.5 ng/mL or cTn-T greater than 0.30 ng/mL. MAIN RESULTS:Of 46,799 noncardiac surgical cases, 209 (0.4%) and 192 (0.4%) suffered cTn leak and MI, respectively. Low SAS (0-4) was associated with increased risk of cTn leak and perioperative MI (univariate odds ratio, 2.76 and 2.06; 95% confidence interval, 2.20-3.45 and 1.57-2.70, respectively). In multivariable analysis, Surgical Apgar Score, age 65 years or older, American Society of Anesthesiologists physical status greater than or equal to III, emergency surgery, history of MI or hypertension, prolonged intraoperative tachycardia (heart rate >100 beats/min for >59 minutes), and prolonged hypotension (mean arterial pressure <40 mm Hg for >2 minutes) were independently associated with cTn leak and perioperative MI. CONCLUSIONS:Low SAS scores (0-4) may be associated with cTn elevation after noncardiac surgery. SAS-based risk stratification may guide perioperative cTn surveillance in lieu of routine postoperative screening.
journal_name
J Clin Anesthjournal_title
Journal of clinical anesthesiaauthors
House LM,Marolen KN,St Jacques PJ,McEvoy MD,Ehrenfeld JMdoi
10.1016/j.jclinane.2016.05.009subject
Has Abstractpub_date
2016-11-01 00:00:00pages
395-402eissn
0952-8180issn
1873-4529pii
S0952-8180(16)30193-3journal_volume
34pub_type
杂志文章abstract：STUDY OBJECT:To investigate the changes in hemodynamics and hypnotic levels during propofol infusion and tracheal intubation with and without fentanyl. DESIGN:Randomized, double-blinded study. SETTING:Teaching hospital. PATIENTS:40 ASA physical status I adult patients scheduled for elective surgery. INTERVENTIONS:P...
journal_title：Journal of clinical anesthesia
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/s0952-8180(01)00375-0
更新日期：2002-03-01 00:00:00
abstract：BACKGROUND AND OBJECTIVE:Hybrid operating room suites with intraoperative magnetic resonance imaging enable image guided surgery in a fully functional operating room environment. While this environment creates challenges to anesthetic care, the effects on anesthetic adverse events and outcomes are largely unknown. This...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2018.10.022
更新日期：2019-05-01 00:00:00
abstract：STUDY OBJECTIVES:To identify airway management and tracheal intubation techniques for glossopexy in infants with preexisting airway obstruction under general anesthesia. DESIGN:Retrospective, observational study. SETTINGS:Operating room of a university hospital between January 2003 and March 2015. All operations were...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2016.10.019
更新日期：2017-02-01 00:00:00
abstract：:A parturient presented at 35 weeks' gestation with worsening neurological symptoms caused by syringomyelia. She underwent urgent cesarean delivery. The etiology and anesthetic considerations for an obstetrical patient with syringomyelia are discussed. ...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2011.03.007
更新日期：2011-12-01 00:00:00
abstract：:We present a case of postoperative cardiac arrest caused by extrinsic occlusion of the right coronary artery by an aortic pseudoaneurysm. Extrinsic impingement upon the coronary arteries may result from several etiologies and lead to cardiac symptoms identical to those caused by intrinsic coronary disease. Extrinsic c...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2005.06.013
更新日期：2006-05-01 00:00:00
abstract：STUDY OBJECTIVE:To determine the immediate effect of epidural blood patch (EBP) on the hearing loss that can accompany postdural puncture headache (PDPH). DESIGN:Prospective open study. SETTING:Anesthetic and otolaryngologic departments at a university hospital. SUBJECTS:16 patients who developed severe PDPH followi...
journal_title：Journal of clinical anesthesia
pub_type： 临床试验,杂志文章
doi：10.1016/0952-8180(95)00053-k
更新日期：1995-09-01 00:00:00
abstract：STUDY OBJECTIVES:To evaluate changes in cerebral tissue oxygen index (TOI) values under the beach chair position before and during general anesthesia in surgical patients with or without cardiovascular risk factors. DESIGN:Prospective study. SETTING:Operating room in the university hospital. PATIENTS:Ninety-one pati...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2015.06.007
更新日期：2015-09-01 00:00:00
abstract：STUDY OBJECTIVE:To study the impact of adding simulation-based education to the pre-intervention mandatory hospital efforts aimed at decreasing central venous catheter-related blood stream infections (CRBSI) in intensive care units (ICU). DESIGN:Pre- and post-intervention retrospective observational investigation. SE...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2012.04.006
更新日期：2012-11-01 00:00:00
abstract：STUDY OBJECTIVE:To understand anesthesiologists' and surgeons' risk attitudes about expected years of life. DESIGN:Prospective study. SETTING:Central operating rooms (ORs) in a university hospital. RESPONDENTS:122 anesthesiologists and surgeons. MEASUREMENTS AND MAIN RESULTS:A 7-page survey questionnaire regarding ...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/s0952-8180(00)00130-6
更新日期：2000-03-01 00:00:00
abstract：STUDY OBJECTIVE:To evaluate the consequences of opioid use for postoperative pain management and the degree to which these consequences may be reduced or minimized with opioid-sparing or opioid-replacement techniques. DESIGN:Literature review relating to the economics of postoperative pain management. Comparisons betw...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章,评审
doi：10.1016/s0952-8180(02)00372-0
更新日期：2002-08-01 00:00:00
abstract：STUDY OBJECTIVE:Medical residents working overnight call shifts experience sleep deprivation and circadian clock disruption. This leads to deficits in sensorimotor function and increases in workplace accidents. Using quick tablet-based tasks, we investigate whether measureable executive function differences exist follo...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2017.04.002
更新日期：2017-08-01 00:00:00
abstract：:Kearns-Sayre syndrome (KSS) is a rare mitochondrial myopathy and often involves cardiac conduction abnormality and muscle weakness. We report a patient with KSS who had an implantable cardioverter-defibrillator (ICD) implanted during general anesthesia with propofol and nitrous oxide (N2O). These anesthetics did not s...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2004.08.002
更新日期：2004-11-01 00:00:00
abstract：INTRODUCTION:There have been numerous reports studying the effect of neuraxial analgesia on breastfeeding success, but the results are inconsistent. METHODS:We performed a literature search in various databases for studies comparing neuraxial analgesia to non-neuraxial or no analgesia. Outcomes were the percentage of ...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章,评审
doi：10.1016/j.jclinane.2020.110105
更新日期：2021-02-01 00:00:00
abstract：:During cataract surgery, both the surgeon and the anesthesiologist need access to the patient's face. At our institution we achieved a working compromise by using an oxygen insufflating hoop, which allowed the surgeon access to the eye and a sterile field. The patient's airway was kept free by the hoop, and the patien...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/0952-8180(89)90024-x
更新日期：1989-01-01 00:00:00
abstract：STUDY OBJECTIVE:To determine the effects of respiratory acidosis and alkalosis by mechanical ventilation on the onset, duration, and recovery times of vecuronium. DESIGN:Randomized, prospective study. SETTING:Operating rooms in the Sapporo Medical University Hospital and Kitami Red Cross Hospital. PATIENTS:90 ASA ph...
journal_title：Journal of clinical anesthesia
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/s0952-8180(01)00361-0
更新日期：2002-03-01 00:00:00
abstract：STUDY OBJECTIVE:To determine which patient parameters best predict left bronchial width (LBW) when selecting the correct size double-lumen tube (DLT). If LBW is known, a DLT that will fit that bronchus can be chosen. DESIGN:Prospective study. SETTING:University medical center. PATIENTS:Three hundred twenty-one conse...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2004.07.008
更新日期：2005-06-01 00:00:00
abstract：:A 3-year-old girl presented for routine closure of her tracheostomy site. She was intubated easily for the procedure, and the wound was closed with a drain in place. In recovery, the mother noticed fullness in the patient's submandibular region, and on examination, the girl had subcutaneous emphysema in the neck bilat...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2016.01.033
更新日期：2016-06-01 00:00:00
abstract：STUDY OBJECTIVE:To ascertain current anesthesia utilization of esophageal and precordial stethoscopes in U.S. anesthesia training programs. DESIGN:Prospective, single-blind, incidence study. SETTING:Operating rooms of three tertiary care hospitals with major academic anesthesiology departments. SUBJECTS:Anesthesia f...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章,多中心研究
doi：10.1016/0952-8180(95)00027-f
更新日期：1995-08-01 00:00:00
abstract：:The neurologic implications of diabetic hyperglycemia depend on whether the ischemic insult is permanent or temporary. Laboratory studies show that following permanent focal ischemia, a situation analogous to stroke, diabetic hyperglycemia is protective in the penumbral region, whereas it may slightly increase infarct...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章,评审
doi：10.1016/s0952-8180(97)00021-4
更新日期：1997-06-01 00:00:00
abstract：STUDY OBJECTIVES:To evaluate the efficacy of intravenous lidocaine and two doses of esmolol for attenuating the cardiovascular responses to laryngoscopy and intubation, and to assess whether a combination of both drugs is more effective than either drug alone. DESIGN:Randomized, prospective, double-blind, placebo-cont...
journal_title：Journal of clinical anesthesia
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/0952-8180(96)00109-2
更新日期：1996-09-01 00:00:00
abstract：STUDY OBJECTIVE:Dexmedetomidine, a highly selective α2-receptor agonist, has been widely used for protection against ischemia-reperfusion (IR) injury. We hypothesized that dexmedetomidine might exert a protective effect on IR injury after hepatectomy. DESIGN:A prospective, randomized, single-blind study was conducted ...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2019.109631
更新日期：2020-05-01 00:00:00
abstract：STUDY OBJECTIVE:To show that a complex motor skill can be taught without requiring active expert faculty participation. DESIGN:Prospective descriptive study. SETTING:Simulation laboratory of an academic anesthesiology department. SUBJECTS:Novice users of the Bullard laryngoscope, predominantly residents. INTERVENTI...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2007.06.004
更新日期：2007-12-01 00:00:00
abstract：STUDY OBJECTIVE:To evaluate the profile of molecular hemostatic markers in patients receiving either spinal or balanced general anesthesia for total hip arthroplasty. DESIGN:Open, randomized, observational study. SETTING:Orthopedic unit and central laboratory of a university hospital. PATIENTS:26 consenting ASA phys...
journal_title：Journal of clinical anesthesia
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/s0952-8180(03)00082-5
更新日期：2003-09-01 00:00:00
abstract：:We present the case of a patient who first presented with unexpected difficult laryngoscopy and intubation after induction of general anesthesia. After multiple failed attempts using direct laryngoscopy, tracheal intubation was successfully performed with the Intubating Laryngeal Mask Airway. He returned to the operat...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2007.04.009
更新日期：2007-12-01 00:00:00
abstract：STUDY OBJECTIVE:To determine risk factors associated with reintubations in adult patients with soft tissue infections. DESIGN:A retrospective case-control design. SETTING:Operating room and postoperative recovery area. PATIENTS:There were 39 patients who presented for surgical intervention of their soft tissue infec...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2016.03.073
更新日期：2016-11-01 00:00:00
abstract：:Neuroleptic malignant syndrome is an uncommon, idiosyncratic, and sometimes life-threatening disorder associated with the use of neuroleptic drugs. The pathogenesis of neuroleptic malignant syndrome is uncertain, but it may be similar to that of malignant hyperthermia (MH). Some of the symptoms of neuroleptic malignan...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/0952-8180(90)90096-l
更新日期：1990-05-01 00:00:00
abstract：STUDY OBJECTIVE:Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune disorder of the neuromuscular junction that manifests with muscle weakness, autonomic and bulbar dysfunction, and increased sensitivity to neuromuscular blocking drugs. The objective of this study is to review perioperative outcomes on a series o...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2014.09.009
更新日期：2014-12-01 00:00:00
abstract：STUDY OBJECTIVE:The aim of the study was to compare the incidence of the use of additional uterotonics before and after the change of carbetocin to oxytocin for the prevention of postpartum hemorrhage after cesarean delivery in women with severe preeclampsia. DESIGN:This was an observational retrospective before-and-a...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/j.jclinane.2016.08.017
更新日期：2016-12-01 00:00:00
abstract：STUDY OBJECTIVE:To examine the acute hemodynamic effects of intravenous (i.v.) nicardipine and its ability to attenuate the hyperdynamic response to electroconvulsive therapy (ECT), when used alone or in combination with labetalol. DESIGN:Prospective, randomized, double-blind, positive-control, clinical investigation....
journal_title：Journal of clinical anesthesia
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/s0952-8180(98)00052-x
更新日期：1998-08-01 00:00:00
abstract：:A 13-year-old girl with Goltz's (Goltz-Gorlin) syndrome (focal dermal hypoplasia) and cloacal exstrophy underwent day surgery cystoscopy. During the administration of inhalation anesthesia by mask, persistent partial upper airway obstruction was noted. Direct laryngoscopy unexpectedly showed variously sized verrucous ...
journal_title：Journal of clinical anesthesia
pub_type： 杂志文章
doi：10.1016/0952-8180(91)90190-x
更新日期：1991-09-01 00:00:00
