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[Cardiovascular morbidity and anesthesia]
1Department of Anesthesia, Veterans Administration Medical Center, University of San Francisco, USA.
Insights
Cardiovascular disease affects many, posing risks like myocardial ischemia (PMI) and stroke during surgery. Research shows these perioperative events are preventable with specific therapies, improving patient outcomes.
Area of Science:
- Cardiology
- Neurology
- Anesthesiology
Context:
- Cardiovascular disease impacts 25% of individuals in Western nations.
- Perioperative settings pose risks of myocardial ischemia (PMI), myocardial infarction, and stroke.
- Aging populations exacerbate the prevalence and impact of cardiovascular disease.
Purpose:
- To review the risks of perioperative cardiovascular morbidity, including PMI and stroke.
- To explore the potential for preventing perioperative myocardial ischemia and stroke.
- To highlight the need for developing anti-ischemic therapies for surgical patients.
Summary:
- Myocardial ischemia and infarction are preventable in high-risk surgical patients using agents like adenosine-related drugs and alpha 2-agonists.
- Perioperative stroke, affecting 3-7% of cardiac surgery patients, may also be preventable with adenosine-regulating agents, though further confirmation is needed.
- Central nervous system dysfunction is common post-cardiac surgery, with limited data for non-cardiac procedures.
Impact:
- Effective perioperative strategies can mitigate significant morbidity and mortality associated with cardiovascular disease.
- Advancements in anti-ischemic therapy for surgical patients are crucial for managing the growing burden of cardiovascular disease.
- Reducing perioperative cardiovascular events has substantial medical, financial, and social benefits.
Abstract:
One of every four persons in the Western industrialised nations has cardiovascular disease. The perioperative setting in those patients is associated with the risk of myocardial ischaemia (PMI) and myocardial infarction, and also with the risk of perioperative stroke and dysfunction of the central nervous system (CNS). Perioperative cardiovascular morbidity represents a major healthcare challenge. The relevance of PMI is well documented. It has been demonstrated in early trials that both myocardial ischaemia and infarction are preventable in high-risk patients undergoing surgery, and that therapeutic agents such as adenosine-related agents, alpha 2-agonists, and other stress modulators can be safely administered to these patients. Regarding perioperative stroke, approximately 3 to 7% of patients undergoing cardiac surgery suffer stroke, with an additional 30% or more suffering in-hospital CNS dysfunction, and 10% suffering moderately severe long-term CNS dysfunction. Few data are available for noncardiac surgery. The number of outcome studies addressing prophylactic or therapeutic options in these patients is quite limited. In fact, only one recent study has established that perioperative stroke is preventable with the use of an adenosine-regulating agent. Thus, it appears that it may be possible to prevent stroke, even though these results require confirmation. Because of the aging of our population, and the medical, financial and social impact of cardiovascular disease, the development of anti-ischaemic therapy, particularly in the surgical patient, will be a critical area of medical research for the next several decades.