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Perioperative myocardial ischemia in patients undergoing elective hip arthroplasty during lumbar regional anesthesia
S C Marsch1, H G Schaefer, K Skarvan
1Department of Anaesthesia, University of Basle/Kantonsspital, Switzerland.
Insights
Perioperative myocardial ischemia, a silent threat, affected 31% of patients undergoing hip surgery. This condition significantly increased the risk of adverse cardiac events post-surgery.
Area of Science:
- Cardiology
- Anesthesiology
- Perioperative Medicine
Background:
- Perioperative myocardial ischemia is a significant predictor of poor patient outcomes.
- It affects up to 41% of patients with existing cardiac conditions or risk factors undergoing non-cardiac surgery.
Purpose of the Study:
- To investigate the prevalence of perioperative myocardial ischemia in patients undergoing elective hip arthroplasty.
- To analyze the characteristics and clinical significance of these ischemic episodes.
Main Methods:
- A study of 52 unselected patients undergoing elective hip arthroplasty under lumbar regional anesthesia.
- Continuous 6-day monitoring using a three-channel Holter monitor.
- Analysis of ischemic episodes in relation to heart rate, clinical presentation, and timing (preoperative, intraoperative, postoperative).
Main Results:
- Myocardial ischemia occurred in 31% of patients (16 out of 52), including some with low preoperative cardiac risk.
- Ninety-six percent of ischemic episodes were clinically silent.
- Postoperative ischemia showed a circadian pattern, with the majority occurring during daytime hours.
- Patients with perioperative ischemia had a 2.6 times higher risk of adverse cardiac events.
Conclusions:
- Perioperative myocardial ischemia is common in patients undergoing hip arthroplasty, often asymptomatic.
- The timing of ischemia, particularly postoperatively, and its association with adverse cardiac events highlight the need for vigilant monitoring.
- These findings underscore the importance of assessing and managing cardiac risk in patients undergoing non-cardiac surgery.
Abstract:
Perioperative myocardial ischemia predicts unfavorable outcomes and occurs in as many as 41% of patients with coronary artery disease or cardiac risk factors undergoing noncardiac surgery. To determine the prevalence of myocardial ischemia, we studied 52 consecutive unselected patients undergoing elective hip arthroplasty during lumbar regional anesthesia. Patients were continuously monitored for 6 days using a three-channel Holter monitor. Ninety-nine episodes of myocardial ischemia occurred in 16 patients (31%), six of whom were considered preoperatively to be at low risk for coronary artery disease. Forty-four percent of the ischemic episodes were preceded or accompanied by a heart rate greater than or equal to 100/min and 56% by a heart rate greater than or equal to 90 beats/min. Ninety-six percent of the ischemic episodes were clinically silent, and 82% were not related to patient care events. Thirteen episodes of myocardial ischemia occurred preoperatively, 1 intraoperatively, and 85 postoperatively. The incidence of postoperative ischemic episodes showed a circadian variation: 44% occurred between 6 AM and noon, 33% between noon and 6 PM, 17% between 6 PM and midnight, and 6% between midnight and 6 AM. Six adverse cardiac events occurred during hospitalization (three of the six among patients with perioperative ischemia) and an additional four events during a follow-up period of 12 months (all four events occurred among patients with perioperative ischemia). Patients with perioperative myocardial ischemia had a relative risk of 2.6 (95% confidence interval 1.3-5.2) to develop an adverse cardiac event postoperatively.