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Diagnostik des kardialen Risikopatienten mit klinischen Methoden

  • A. Hoeft
Conference paper
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Part of the Refresher Course Aktuelles Wissen für Anästhesisten book series (REFRESHER COUR, volume 21)

Zusammenfassung

Erkrankungen des kardiovaskulären Systems stellen einen erheblichen Risikofaktor für Patienten dar, die sich einem operativen Eingriff unterziehen müssen. Dies gilt v. a. für eine koronare Herzkrankheit (KHK) [21], angeborene und erworbene Herzklappenfehler sowie für eine ausgeprägte chronische Herzinsuffizienz [16]. Aber auch eine Hypertonie geht mit einer deutlich höheren perioperativen Morbiditäts- und Mortalitätsrate einher [11, 12, 30]. Das Bestreben des Anästhesisten ist es daher, diese Erkrankungen bei der Prämedikationsvisite zu erfassen und hinsichtlich ihres Schweregrades einzuschätzen. Bei Wahleingriffen besteht das Ziel darin, den Patienten optimal auf die bevorstehenden Operationen vorzubereiten. Gegebenenfalls müssen präoperativ weitere Untersuchungen veranlaßt werden. Dabei ist im Einzelfall außer dem individuellen Risiko einer Narkose v. a. entscheidend, inwieweit durch eine Optimierung der Therapie noch eine Verbesserung des Gesundheitszustands erreicht werden kann. Die Tatsache, daß der präoperative Zustand des Patienten maßgeblich das postoperative „Outcome“ beeinflußt [16, 21–23], legt zwar nahe, daß eine präoperative Optimierung der Therapie ebenfalls zu einem besseren postoperativen „Outcome“ führt, beweist dies jedoch keinesfalls. Bislang liegen keine kontrollierten oder gar randomisierten Studien vor, die diese Vermutung bestätigen.

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Literatur

  1. 1.
    Bechtold HH Jr. (1981) Committee on Anaesthesia Study. Anaesthetic related deaths:1969–1976. N C Med J 42: 253Google Scholar
  2. 2.
    Benchimol A, Harris CL, Desser KB (1973) Resting electrocardiogramm in major coronary artery disease. JAMA 224: 1489PubMedCrossRefGoogle Scholar
  3. 3.
    Berglund G, Wilhelmen L, Sannerstedt R (1978) Coronary heart-disease after treatment of hypertension. Lancet I: 1Google Scholar
  4. 4.
    Borer JS, Brensike JF, Redwood DR (1975) Limitations of the electrogardiographic response to exercise inpredicting coronary artery disease. N Engl J Med 293: 367PubMedCrossRefGoogle Scholar
  5. 5.
    Cohen MM, Duncan PG (1981) Physical status score and trends in anesthetic complications. J Clin Epidemiol 41: 83CrossRefGoogle Scholar
  6. 6.
    Farnett L, Mulrow CD, Linn WD (1991) The J-curve phenomenon and the treatment of hypertension. Is there a point beyond which pressure reduction is dangerous? JAMA 265: 489PubMedCrossRefGoogle Scholar
  7. 7.
    Farrow SC, Fowkes FGR, Lunn JN (1982) Epidemiology in anaesthesia II: Factors affecting mortality in hospital. Br J Anaesth 54: 811Google Scholar
  8. 8.
    Fleisher LA, Barash PG (1992) Preoperative cardiac evaluation for noncardiac surgery: A functional approach. Aesth Analg 74: 568Google Scholar
  9. 9.
    Fowkes FGR, Lunn JN, Farrow SC (1982) Epidemiology in anaesthesia III: Mortality risk in patients with coexisting physical disease. Br J Anaesth 54: 819Google Scholar
  10. 10.
    Gibson RS, Beller GA, Gheorgiade M, (1986) The prevalence of residual myocardial ischemia 2 weeks after uncomplicated non Q-wave infarction: a prospective natural history study. Circulation 73: 1186PubMedCrossRefGoogle Scholar
  11. 11.
    Goldman L, Caldera DL, Nussbaum SR,(1977) Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 297: 845PubMedCrossRefGoogle Scholar
  12. 12.
    Goldman L, Caldera DL (1979) Risks of general anesthesia and elective operation in the hypertensive patient. Anesthesiology 50: 285PubMedCrossRefGoogle Scholar
  13. 13.
    Goldschlager N (1982) Use of the treadmill test in the diagnosis of coronary artery disease in patients with chest pain. Ann Int Med 97: 383PubMedGoogle Scholar
  14. 14.
    Hertzer NR, Young JR, Beven EG (1987) Late results of coronary bypass in patients with infrarenal aortic aneurysmas. The Cleveland Clinic Study. Ann Surg 205: 360Google Scholar
  15. 15.
    Heyman A, Wilkinson WE, Heyden S (1980) Risk of stroke in asymptomatic persons with cervical arterial bruits. A population study in Evans Country, Georgia. N Engl J Med 302: 838Google Scholar
  16. 16.
    Higgins TL, Estefanous FG, Loop FD,(1992) Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass surgery. JAMA 267: 2344PubMedCrossRefGoogle Scholar
  17. 17.
    Hypertension Detection and Follow-up Program Cooperative Group (1982) The effect of treatment on mortality in „mild“ hypertension. N Engl J Med 307: 976Google Scholar
  18. 18.
    Lalka SG, Sawada SG, Dalsing MC (1992) Dobutamine stress echocardiography as a predictor of cardiac events associated with aortic surgery. J Vasc Surg 15: 831PubMedCrossRefGoogle Scholar
  19. 19.
    Levy D, Garrison RJ, Savage DD (1989) Left ventricular mass and the incidence of coronary heart disease in an elderly cohort: The Framingham heart study. Ann Intern Med 110: 101Google Scholar
  20. 20.
    Lunn IN Farrow SC, Fowkes FGR (1982) Epidemiology in anaesthesia I: Anaesthetic practice over 20 years. Br J Anaesth 54: 803PubMedCrossRefGoogle Scholar
  21. 21.
    Mangano DT (1990) Perioperative cardiac morbidity. Anesthesiology 72: 153PubMedCrossRefGoogle Scholar
  22. 22.
    Mangano DT, Browner WS, Hollenberg M, (1990) Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group [see comments]. N Engl J Med 323: 1781Google Scholar
  23. 23.
    Mangano DT, Browner WS, Hollenberg M,(1992) Long — term cardiac prognosis following noncardiac surgery. JAMA 268: 233PubMedCrossRefGoogle Scholar
  24. 24.
    Mantha S, Roizen MF, Barnard J(1994) Relative effectiveness of preoperative nonivasive cardiac evaluation tests on predicting adverse cardiac outcomes following vascular surgery. Anesth Analg 79: 422PubMedCrossRefGoogle Scholar
  25. 25.
    Marx GF, Mateo CV, Orkin LR (1973) Computer analysis of postanesthetic deaths. Anesthesiology 39: 54PubMedCrossRefGoogle Scholar
  26. 26.
    Mckann RL, Clements FM (1989) Silent myocardial ischemia in patients undergoing peripheral vascular surgery: Incidence and association with perioperative cardiac morbidity and mortality. J Vasc Surg 9: 583Google Scholar
  27. 27.
    Multiple Risk Factor Intervention Trial Research Group (1982) Multiple risk factor intervention trial. Risk factor changes and mortality results. JAMA 248: 1465Google Scholar
  28. 28.
    Olsson GL, Hallen B (1988) Cardiac arrest during anesthesia. A computer aided study in 250543 anaesthetics. Acta Anaesthesiol Scand 32: 653PubMedCrossRefGoogle Scholar
  29. 29.
    Pedersen T, Eliasen K, Henriksen E (1990) A prospective study of risk factors and cardiopulmonary complications associated with anesthesia and surgery: risk indicators of cardiopulmonary morbidity. Acta Anaesthesiol Scand 34: 144PubMedCrossRefGoogle Scholar
  30. 30.
    Prys-Roberts C, Meloche R, Foex P (1971) Studies of anesthesia in relation to hypertension. I: Cardiovascular responses of treated and untreated patients. Br J Anesth 43: 122Google Scholar
  31. 31.
    Raby KE, Goldmann L, Creager MA (1989) Correlation between preoperative ischemia and major cardiac events after peripheral vascular surgery. N Engl J Med 321: 1296Google Scholar
  32. 32.
    Roizen MF (1994) Anesthetic implications of concurrent disease. In: Miller RD (ed) Anesthesia, 4th edn. Churchill Livingstone, New York, pp 903–1014Google Scholar
  33. 33.
    Ropper AH, Wechsler LR, Wilson LS (1982) Carotid bruit and the risk of stroke in elective surgery. N Engl J Med 307: 1388PubMedCrossRefGoogle Scholar
  34. 34.
    SHEP Cooperative Study Group (1991) Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 265: 3255Google Scholar
  35. 35.
    Sprague HB (1929) The heart in surgery. An analysis of results of surgery on cardiac patients during the past ten years at the Massachusetts General Hospital. Surg Gynecol Obstet 49: 54Google Scholar
  36. 36.
    Stone JG, Foex P, Sear JW (1988) Risk of myocardial ischemia during anesthesia in treated and untreated hypertensive patients. Br J Anesth 61: 675CrossRefGoogle Scholar
  37. 37.
    Tischler MD, Lee TH, Hirsch AT (1992) Prediction of major cardiac events after peripheral vascular surgery using dipyramidole echocardiography. Am J Card 126: 593Google Scholar
  38. 38.
    Tomatis LA, Fierens EE, Verbrugge GP (1972) Evaluation of surgical risk in peripheral vascular disease by coronary angiography: a series of 100 cases. Surgery 71: 429PubMedGoogle Scholar
  39. 39.
    Vacanti CJ, Van Houten RJ, Hill RC (1970) A statistical analysis of the relationsship of physical status to postoperative mortality in 68,388 cases. Anesth Analg 49: 564PubMedCrossRefGoogle Scholar
  40. 40.
    Veterans Administration Study on Antihypertensive Agents (1967) Effects of treatment on morbidity in hypertension. JAMA 202: 1028Google Scholar
  41. 41.
    Veterans Administration Cooperative Study Group on Antihypertensive Agents (1970) Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg. JAMA 213: 1143Google Scholar
  42. 42.
    Weiner DA Ryan TJ, McCabe CH(1979) Exercise stress testing. Correlations among history of angina, ST- segment response and prevalence of coronary ertery disease in the Coronary Artery Surgery Study (CASS). N Engl J Med 301: 230Google Scholar
  43. 43.
    Williams GH (1994) Hypertensive vascular disease. In: Isselbacher KJ, Braunwald E, Wilson JD, Martin JB, Fauci AS, Kasper DL (eds) Harrison principles of internal medicine, 13th edn. McGraw-Hill Inc, New York, p 1124Google Scholar
  44. 44.
    Wolfsthal SD (1989) The clinical characteristics and perioperative blood pressure lability in hypertensive patients referred for preoperative medical evaluation. Clin Res 37: 8034 AGoogle Scholar
  45. 45.
    Ziffren SE, Hartford CE (1972) Comparative mortality for various surgical operations in older versus younger age groups. J Am Geriatr Soc 20: 485PubMedGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1995

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  • A. Hoeft

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