[Postoperative patient management. Perioperative myocardial infarct]

A FREQUENT AND SEVERE EVENT: The incidence and the pathogenic mechanisms of cardiac complications in general surgery patients are now well described. Acute myocardial necrosis, the most frequent complication, is observed in 3 to 5% of patients at risk. Most are silent subendocardial lesions, but may have a short-term or mid-term life-threatening effect in these surgery patients. EARLY POSTOPERATIVE PERIOD: In most patients, cardiac events occur within 48 hours of surgery. Diagnosis is confirmed by elevated troponin I. The immediate postoperative period is characterized by increased left ventricular load and metabolic disturbances, increased release of catecholinergic mediators and hypercoagulability, factors related to the effect of anesthesia on circulation and surgical stimuli. These modifications compromise the energy balance in the myocardium and favor the development of left ventricular failure. ECG RECORDINGS: Continuous recordings in the postoperative period have shown that although the number of episodes of myocardial ischemia is not affected during surgery, their number doubles during the postoperative period, a factor predicting postoperative infarction.

Cardiovascular and anti-aggregate therapy should be adapted in patients with an underlying heart or coronary condition. Postoperative circulatory load and hyperaggregability should be controlled. This involves preventing hypothermia, intensive analgesia and, in some cases, cardiovascular therapy using beta blockers or alpha 2 agonists.