Does perioperative myocardial ischemia lead to postoperative myocardial infarction?

Abstract:

:To determine if a relationship exists between perioperative myocardial ischemia (ST segment depression greater than or equal to 0.1 mV) and postoperative myocardial infarction (PMI), nonparticipating observers recorded all ECG, hemodynamic, and other events between arrival of patients in the operating room and onset of cardiopulmonary bypass during 1,023 elective coronary artery bypass operations (CABG). The roles of preoperative patient characteristics, quality of the operation limited by disease as rated by the surgeon and duration of ischemic cardiac arrest as risk factors for PMI also were quantified. ECG ischemia occurred in 36.9% of all patients, with almost half the episodes occurring before induction of anesthesia. PMI was almost three times as frequent in patients with ischemia (6.9% vs. 2.5%) and was independent of when ischemia occurred. Ischemia was related significantly to tachycardia but not hypertension nor hypotension and was frequent in the absence of any hemodynamic abnormalities. The anesthesiologist whose patients had the highest rate of tachycardia and ischemia had the highest rate of PMI. Although neither single nor multiple preoperative patient characteristics related to PMI, suboptimal quality of operation and prolonged ischemic cardiac arrest increased the likelihood of PMI independent of the occurrence of myocardial ischemia. The authors conclude that perioperative myocardial ischemia is common in patients undergoing CABG, occurs randomly as well as in response to hemodynamic abnormalities, and is one of three independent risk factors the authors identified as related to PMI. PMI is unrelated to preoperative patient characteristics such as ejection fraction and left main coronary artery disease, and its frequency will relate primarily to perioperative management rather than patient selection.

journal_name

Anesthesiology

journal_title

Anesthesiology

authors

Slogoff S,Keats AS

doi

10.1097/00000542-198502000-00002

subject

Has Abstract

pub_date

1985-02-01 00:00:00

pages

107-14

issue

2

eissn

0003-3022

issn

1528-1175

journal_volume

62

pub_type

杂志文章
  • Volatile anesthetics depress Ca2+ transients and glutamate release in isolated cerebral synaptosomes.

    abstract:BACKGROUND:The current study was performed to determine whether volatile anesthetics may include as part of their action in the central nervous system the depression of presynaptic transmitter release by alteration in intrasynaptic [Ca2+] ([Ca2+]i). METHODS:Guinea pig cerebrocortical synaptosomes were studied at 37 de...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199509000-00019

    authors: Miao N,Frazer MJ,Lynch C 3rd

    更新日期:1995-09-01 00:00:00

  • Ulnar neuropathy. Incidence, outcome, and risk factors in sedated or anesthetized patients.

    abstract:BACKGROUND:Ulnar neuropathy is well-recognized as a potential complication of procedures performed on anesthetized patients. However, reported outcomes and risk factors for this problem are based on small series and anecdotes. METHODS:We retrospectively reviewed the perioperative courses of 1,129,692 consecutive patie...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:

    authors: Warner MA,Warner ME,Martin JT

    更新日期:1994-12-01 00:00:00

  • Biotransformation of isoflurane: urinary and serum fluoride ion and organic fluorine.

    abstract::The serum and urinary concentrations of fluorinated metabolites of isoflurane after inhalation of three different concentrations of isoflurane were studied in 18 ASA physical status 1 or 2 patients, scheduled for orthopedic or otolaryngeal surgery. Isoflurane was administered for 60 min during fentanyl-nitrous oxide-o...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:

    authors: Davidkova T,Kikuchi H,Fujii K,Mukaida K,Sato N,Kawachi S,Morio M

    更新日期:1988-08-01 00:00:00

  • Deficit Accumulation and Phenotype Assessments of Frailty Both Poorly Predict Duration of Hospitalization and Serious Complications after Noncardiac Surgery.

    abstract:BACKGROUND:Frailty is associated with adverse postoperative outcomes, but it remains unclear which measure of frailty is best. This study compared two approaches: the Modified Frailty Index, which is a deficit accumulation model (number of accumulated deficits), and the Hopkins Frailty Score, which is a phenotype model...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0000000000002959

    authors: Sonny A,Kurz A,Skolaris LA,Boehm L,Reynolds A,Cummings KC 3rd,Makarova N,Yang D,Sessler DI

    更新日期:2020-01-01 00:00:00

  • Intrathecal gabapentin to treat chronic intractable noncancer pain.

    abstract:BACKGROUND:Oral gabapentin is approved as an anticonvulsant medication and to treat postherpetic neuralgia. Its nonopioid properties and presumed spinal site of analgesic action made the study on intrathecal gabapentin attractive to establish the minimum effective dose for a later, pivotal trial. METHODS:The authors e...

    journal_title:Anesthesiology

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1097/ALN.0b013e3182a10fbf

    authors: Rauck R,Coffey RJ,Schultz DM,Wallace MS,Webster LR,McCarville SE,Grigsby EJ,Page LM

    更新日期:2013-09-01 00:00:00

  • Regional and global myocardial circulatory and metabolic effects of isoflurane and halothane in patients with steal-prone coronary anatomy.

    abstract::The use of isoflurane in patients with coronary artery disease remains controversial because of the possibility of "coronary steal". In this study, the effects of isoflurane and halothane on global and regional myocardial blood flow and metabolism were compared, and the relationship between steal-induced myocardial is...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-199111000-00006

    authors: Pulley DD,Kirvassilis GV,Kelermenos N,Kater K,Barzilai B,Genton RE,Efstathiou C,Lappas DG

    更新日期:1991-11-01 00:00:00

  • Does a higher positive end expiratory pressure decrease mortality in acute respiratory distress syndrome? A systematic review and meta-analysis.

    abstract:BACKGROUND:Positive end expiratory pressure (PEEP) is an important component of therapy in patients with acute lung injury or acute respiratory distress syndrome. The independent effect of PEEP on mortality is currently unknown. METHODS:A systematic review and meta-analysis of randomized controlled clinical trials com...

    journal_title:Anesthesiology

    pub_type: 杂志文章,meta分析,评审

    doi:10.1097/ALN.0b013e31819fae06

    authors: Phoenix SI,Paravastu S,Columb M,Vincent JL,Nirmalan M

    更新日期:2009-05-01 00:00:00

  • Parental presence during induction of anesthesia: physiological effects on parents.

    abstract:BACKGROUND:The authors conducted a randomized controlled trial to determine whether parental presence during induction of anesthesia (PPIA) is associated with parental physiologic and behavioral manifestations of stress. METHODS:Children and their parents (N = 80) were randomly assigned to one of three groups: (1) PPI...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-200301000-00013

    authors: Kain ZN,Caldwell-Andrews AA,Mayes LC,Wang SM,Krivutza DM,LoDolce ME

    更新日期:2003-01-01 00:00:00

  • Positive experimental demonstration of the negative brain "protective" effects of anesthetics following cardiac arrest.

    abstract::The cerebral metabolic effects of a massive dose of thiopental (177 mg/kg) were investigated in seven dogs. The systemic circulation was supported with an extracorporeal circuit. At an infusion rate of 2 mg/kg/min, cerebral oxygen consumption (CMR(O(2))) decreased progressively until cerebral electrical silence was pr...

    journal_title:Anesthesiology

    pub_type: 评论,杂志文章

    doi:10.1097/00000542-200210000-00036

    authors: Michenfelder JD

    更新日期:2002-10-01 00:00:00

  • Effect of pretreatment with intrathecal excitatory amino acid receptor antagonists on the development of pain behavior caused by plantar incision.

    abstract:BACKGROUND:Drugs that block spinal excitatory amino acid receptor activation may prevent pain after surgery. The authors previously studied the effect of excitatory amino acid receptor antagonists after incision. In the present study, we examined the role of N-methyl-d-aspartate (NMDA), non-NMDA, and metabotropic gluta...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200008000-00029

    authors: Pogatzki EM,Zahn PK,Brennan TJ

    更新日期:2000-08-01 00:00:00

  • A focal cryogenic brain lesion does not reduce the minimum alveolar concentration for halothane in rats.

    abstract:BACKGROUND:A focal cortical cryogenic brain injury has been reported to reduce the brain pentobarbital concentrations needed to prevent movement in response to pain in rats. This occurred despite any apparent behavioral changes in the awake animals. To determine whether this was true with other anesthetics, the authors...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199307000-00020

    authors: Todd MM,Weeks JB,Warner DS

    更新日期:1993-07-01 00:00:00

  • New ultrathin-walled endotracheal tube with a novel laryngeal seal design. Long-term evaluation in sheep.

    abstract:BACKGROUND:A new endotracheal tube (ETT) was fabricated and tested in sheep. It had no tracheal cuff; airway seal was achieved at the level of the glottis through a no-pressure seal made of "gills"; the laryngeal portion was oval-shaped; and the wall thickness was reduced to 0.2 mm. METHODS:Sheep were tracheally intub...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199601000-00019

    authors: Reali-Forster C,Kolobow T,Giacomini M,Hayashi T,Horiba K,Ferrans VJ

    更新日期:1996-01-01 00:00:00

  • Preanesthetic medication in children: a comparison of oral transmucosal fentanyl citrate versus placebo.

    abstract::Initial studies have suggested that oral transmucosal fentanyl citrate (OTFC) in a dose of 15-20 micrograms/kg may be a safe and effective preanesthetic medication in children and adults, but this has not been demonstrated in a randomized, double-blind fashion. The purpose of this study was to determine in a randomize...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

    authors: Feld LH,Champeau MW,van Steennis CA,Scott JC

    更新日期:1989-09-01 00:00:00

  • Isoflurane postconditioning protects against reperfusion injury by preventing mitochondrial permeability transition by an endothelial nitric oxide synthase-dependent mechanism.

    abstract:BACKGROUND:The role of endothelial nitric oxide synthase (eNOS) in isoflurane postconditioning (IsoPC)-elicited cardioprotection is poorly understood. The authors addressed this issue using eNOS mice. METHODS:In vivo or Langendorff-perfused mouse hearts underwent 30 min of ischemia followed by 2 h of reperfusion in th...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0b013e3181c4a607

    authors: Ge ZD,Pravdic D,Bienengraeber M,Pratt PF Jr,Auchampach JA,Gross GJ,Kersten JR,Warltier DC

    更新日期:2010-01-01 00:00:00

  • No evidence for blood flow redistribution with isoflurane or halothane during acute coronary artery occlusion in fentanyl-anesthetized dogs.

    abstract::The present study examines the postulate that isoflurane, in contrast to halothane, causes redistribution of blood flow away from an ischemic myocardial region through vasodilation of adjacent normally perfused myocardium. The study was performed in open-chest dogs anesthetized with fentanyl; ischemia was induced by o...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199111000-00018

    authors: Moore PG,Kien ND,Reitan JA,White DA,Safwat AM

    更新日期:1991-11-01 00:00:00

  • Sonographic visualization and ultrasound-guided block of the third occipital nerve: prospective for a new method to diagnose C2-C3 zygapophysial joint pain.

    abstract:BACKGROUND:Chronic neck pain after whiplash injury is caused by cervical zygapophysial joints in 50% of patients. Diagnostic blocks of nerves supplying the joints are performed using fluoroscopy. The authors' hypothesis was that the third occipital nerve can be visualized and blocked with use of an ultrasound-guided te...

    journal_title:Anesthesiology

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/00000542-200602000-00016

    authors: Eichenberger U,Greher M,Kapral S,Marhofer P,Wiest R,Remonda L,Bogduk N,Curatolo M

    更新日期:2006-02-01 00:00:00

  • Role of monitoring devices in prevention of anesthetic mishaps: a closed claims analysis.

    abstract::Anesthesiologist-reviewers examined 1,175 anesthetic-related closed malpractice claims from 17 professional liability insurance companies. The claims were filed between 1974 and 1988. The reviewers were asked to determine if the negative outcome was preventable by proper use of additional monitoring devices available ...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-198910000-00010

    authors: Tinker JH,Dull DL,Caplan RA,Ward RJ,Cheney FW

    更新日期:1989-10-01 00:00:00

  • The effects of halothane on voltage-dependent calcium channels in isolated Langendorff-perfused rat heart.

    abstract:BACKGROUND:Halothane has been previously shown in vitro to decrease both the inward calcium current in isolated cells and the density of calcium antagonist binding sites in cardiac sarcolemmal membranes prepared from several species, including humans, presumably contributing to the negative inotropic effects seen with ...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199411000-00015

    authors: Lee DL,Zhang J,Blanck TJ

    更新日期:1994-11-01 00:00:00

  • Sodium channel in human malignant hyperthermia.

    abstract:BACKGROUND:The abundance of a specific sodium channel subunit (SkM2) appeared to be altered in vitro in cell cultures from persons susceptible to malignant hyperthermia. This study sought to determine whether these findings are artifacts of cell culture or whether they may be relevant to malignant hyperthermia. METHOD...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199705000-00004

    authors: Fletcher JE,Wieland SJ,Karan SM,Beech J,Rosenberg H

    更新日期:1997-05-01 00:00:00

  • Cardiovascular responses to the induction of mild hypothermia in the presence of epidural anesthesia.

    abstract:BACKGROUND:The combining of epidural anesthesia with general anesthesia impairs central and peripheral thermoregulatory control and therefore is often accompanied by unintended intraoperative hypothermia. However, little is known about the cardiovascular response to hypothermia during combined epidural and general anes...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200104000-00023

    authors: Yoshida M,Shibata K,Itoh H,Yamamoto K

    更新日期:2001-04-01 00:00:00

  • Toxicity and distribution of lidocaine in nonasphyxiated and asphyxiated baboon fetuses.

    abstract::The dosage and blood concentration of lidocaine required to produce central nervous and cardiovascular system toxicity in both nonasphyxiated and asphyxiated fetuses were determined in ten pregnant baboons with fetuses of average gestation of 158 days (term, 185 days). Lidocaine was infused into the fetal jugular vein...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-198103000-00002

    authors: Morishima HO,Covino BG

    更新日期:1981-03-01 00:00:00

  • Cyclosporine-inhibitable Cerebral Drug Transport Does Not Influence Clinical Methadone Pharmacodynamics: Erratum.

    abstract::[This corrects the article on p. 1281 in vol. 121, issue 6, PMID: 25072223.]. ...

    journal_title:Anesthesiology

    pub_type: 已发布勘误

    doi:10.1097/01.anes.0000470960.33159.09

    authors:

    更新日期:2015-10-01 00:00:00

  • Cardiorespiratory effects of positive end-expiratory pressure during progressive tidal volume reduction (permissive hypercapnia) in patients with acute respiratory distress syndrome.

    abstract:BACKGROUND:In patients with acute respiratory distress syndrome (ARDS), the ventilatory approach is based on tidal volume (VT) of 10-15 ml/kg and positive end-expiratory pressure (PEEP). To avoid further pulmonary injury, decreasing VT and allowing PaCO2 to increase (permissive hypercapnia) has been suggested. Effects ...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199510000-00010

    authors: Ranieri VM,Mascia L,Fiore T,Bruno F,Brienza A,Giuliani R

    更新日期:1995-10-01 00:00:00

  • Vecuronium neuromuscular blockade reflects liver function during hepatic autotransplantation in pigs.

    abstract:BACKGROUND:Rapid assessment of hepatic function early after reperfusion of the liver graft is of great importance, because it may allow for prompt detection of incipient hepatic graft failure. The current study was undertaken to determine whether the continuous recording of neuromuscular transmission could be used as a...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199407000-00023

    authors: Pittet JF,Morel DR,Mentha G,Schopfer C,Belenger J,Benakis A,Tassonyi E

    更新日期:1994-07-01 00:00:00

  • Inhibition by ether of glucose-stimulated insulin secretion in isolated pieces of rat pancreas.

    abstract::Addition of glucose (16.7 mM) to isolated pieces of rat pancreas increased insulin secretion 5.4-fold over basal secretion rates. Ether at 1, 1.5 and 2 MAC inhibited this insulinogenic effect of glucose in a dose-related manner by 5, 18 (P less than 0.01) and 29 (P less than 0.01) per cent, respectively. ...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-197907000-00007

    authors: Gingerich RL,Paradise RR,Wright PH

    更新日期:1979-07-01 00:00:00

  • Ventilatory effects of dexmedetomidine, atipamezole, and isoflurane in dogs.

    abstract::Dexmedetomidine (DMED) is a novel alpha 2 adrenergic agonist that has been shown to have potent analgesic and anesthetic sparing effects. This study was designed to investigate the effects of DMED, both alone and combined with isoflurane, on resting ventilation, the hypercapnic response, and the hypoxic response in do...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199204000-00014

    authors: Nguyen D,Abdul-Rasool I,Ward D,Hsieh J,Kobayashi D,Hadlock S,Singer F,Bloor B

    更新日期:1992-04-01 00:00:00

  • Length-dependent regulation of left ventricular function in coronary surgery patients.

    abstract:BACKGROUND:Load-dependent impairment of left ventricular (LV) function was observed after leg elevation in a subgroup of coronary surgery patients. The present study investigated underlying mechanisms by comparing hemodynamic effects of an increase in LV systolic pressures with leg elevation to effects of a similar inc...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199908000-00011

    authors: De Hert SG,Gillebert TC,Ten Broecke PW,Moulijn AC

    更新日期:1999-08-01 00:00:00

  • Incidence and predictors of difficult and impossible mask ventilation.

    abstract:BACKGROUND:Mask ventilation is an essential element of airway management that has rarely been studied as the primary outcome. The authors sought to determine the incidence and predictors of difficult and impossible mask ventilation. METHODS:A four-point scale to grade difficulty in performing mask ventilation (MV) is ...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200611000-00007

    authors: Kheterpal S,Han R,Tremper KK,Shanks A,Tait AR,O'Reilly M,Ludwig TA

    更新日期:2006-11-01 00:00:00

  • Acute pain management. Programs in U.S. hospitals and experiences and attitudes among U.S. adults.

    abstract:BACKGROUND:The objective of the survey was to assess the status of acute pain management in U.S. hospitals and attitudes of adults in the U.S. toward postoperative pain management, information that has not been previously available. METHODS:Two telephone questionnaire surveys were conducted U.S. hospital participants,...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199511000-00023

    authors: Warfield CA,Kahn CH

    更新日期:1995-11-01 00:00:00

  • High-efficiency delivery of salbutamol with a metered-dose inhaler in narrow tracheal tubes and catheters.

    abstract::We sought to determine the percent delivery by metered-dose inhaler (MDI) of a preparation of salbutamol (albuterol) to the distal end of either pediatric-size tracheal tubes or a narrow-gauge catheter. A bench model consisting of a swivel actuator; 3.0-6.0-mm ID tracheal tubes all 16 cm in length or a 19-G (standard ...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199102000-00024

    authors: Taylor RH,Lerman J

    更新日期:1991-02-01 00:00:00