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Plasma catecholamine concentrations during abdominal aortic aneurysm surgery: the link to perioperative myocardial
T S Riles1, F S Fisher, S Schaefer
1Department of Surgery, New York University Medical Center, NY 10016.
Insights
Peripheral vascular surgery patients face high cardiac risks. This study shows elevated plasma catecholamines during aortic aneurysm repair, suggesting a hormonal link to perioperative myocardial ischemia.
Area of Science:
- Cardiology
- Vascular Surgery
- Endocrinology
Background:
- Cardiac disease is the primary cause of death after peripheral vascular procedures.
- The exact cause of myocardial infarction in these patients is unknown.
- Beta-adrenergic blockers improve outcomes, hinting at a role for catecholamines.
Purpose of the Study:
- To determine if plasma catecholamine levels increase during abdominal aortic aneurysm repair.
- To investigate the hormonal component of perioperative myocardial ischemic events.
Main Methods:
- Serial plasma epinephrine and norepinephrine levels were measured in 18 patients undergoing abdominal aortic aneurysm repair.
- Measurements were taken preoperatively, during surgery, and postoperatively.
Main Results:
- Plasma epinephrine levels significantly increased from baseline during and after surgery.
- Plasma norepinephrine levels significantly increased at 24 hours postoperatively.
- All patients exhibited abnormally high serum catecholamine levels.
Conclusions:
- Abnormally high perioperative catecholamine levels are common in patients undergoing aortic surgery.
- These findings support the hypothesis that hormonal factors contribute to perioperative myocardial ischemia.
- Further research into the role of catecholamines in cardiac events after vascular surgery is warranted.
Abstract:
Cardiac disease continues to be the leading cause of morbidity and mortality following peripheral vascular surgical procedures. Although the mechanism of sudden myocardial infarction remains elusive, many possibilities exist. The role of catecholamines is intriguing in view of the evidence that beta-adrenergic blockers reduce cardiac morbidity and mortality in vascular surgical patients. To ascertain whether the plasma catecholamine levels rise significantly during abdominal aortic aneurysm repair, serial determinations of plasma epinephrine and norepinephrine levels were performed in 18 patients. Epinephrine levels rose significantly from preoperative baseline values both during the operation and postoperatively, and norepinephrine levels rose significantly at 24 hours postoperatively. Although only one patient studied developed a myocardial infarction, the finding that patients undergoing aortic surgery uniformly experienced abnormally high serum catecholamine levels supports other evidence that perioperative myocardial ischemic events have a hormonal component.