Perioperative Mortality is Reduced by Cardiovascular Optimization

  • O. Boyd
  • R. M. Grounds
  • E. D. Bennett
Conference paper
Part of the Yearbook of Intensive Care and Emergency Medicine 1994 book series (YEARBOOK, volume 1994)

Abstract

Throughout the developed world increasingly complex surgery is being offered to an elderly population. Many of the procedures were pioneered in young, fit subjects but are now virtually routine in higher risk, elderly patients with various concurrent disease states. The perioperative mortality for these patients is high, and most of the patients who do not survive will die from multiple organ dysfunction syndrome (MODS) which accounts for up to 80% of surgical intensive care deaths in the US, and for which the prognosis has altered little in the last 20 years [1]. There seems to be a widespread assumption that this high perioperative mortality is the inevitable consequence of performing complicated surgery on high risk patients, and is often justified by pointing out that the patients involved “have been given a chance” by undergoing surgery.

Keywords

Catheter Ischemia Urea Dopamine Creatinine 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Deitch EA (1993) Overview of multiple organ failure. In: Critial care: State of the art. Society of critical care medicine Anaheim, Ca, pp 131–168Google Scholar
  2. 2.
    Pfluger E (1872) Über die Diffusion des Sauerstoffs, den Ord and die Grenze der Oxydationsprozesse im thierischen Organismus. Pfluger’s Arch. Gesamte Physiologie Menschen Thiere, pp 43–64Google Scholar
  3. 3.
    Cournand A, Riley RL, Bradley SE, et al (1943) Studies of the circulation in clinical shock. Surgery 13: 964–995Google Scholar
  4. 4.
    Ganz W (1971) A new technique for measurement of cardiac output by thermodilution in man. Am J Cardiol 27: 392–396PubMedCrossRefGoogle Scholar
  5. 5.
    Boyd AR, Tremblay RE, Spencer FC, Bahnson HT (1959) Estimation of cardiac output soon after intracardiac surgery with cardiopulmonary bypass. Ann Surg 150: 613–625PubMedCrossRefGoogle Scholar
  6. 6.
    Clowes GHA Jr, Del Guercio LRM (1960) Circulatory response to trauma of surgical operations. Metabolism 9: 67–81PubMedGoogle Scholar
  7. 7.
    Clowes GHA, Vucinci M, Weidner MG (1966) Circulatory and metabolic alterations associated with survival or death in peritonitis. Ann Surg 163: 866–885PubMedCrossRefGoogle Scholar
  8. 8.
    Topkins MJ, Artusio JF (1964) Myocardial infarction and surgery: A five year study. Anesth Analg 43: 716–720PubMedCrossRefGoogle Scholar
  9. 9.
    Goldman L, Caldera DL, Nussbaum SR, et al (1977) Multifactorial index of risk in non-cardiac surgical procedures. N Eng J Med 297: 845–850CrossRefGoogle Scholar
  10. 10.
    Rao TLK, Jacobs KH, El-Etr AA (1983) Reinfarction following anesthesia in patients with myocardial infarction. Anesthesiology 59: 499–505PubMedCrossRefGoogle Scholar
  11. 11.
    Mangano DT (1990) Perioperative cardiac morbidity. Anesthesiology 72: 153–184PubMedCrossRefGoogle Scholar
  12. 12.
    Shoemaker WC, Chang PC, Czer LSC, et al (1979) Cardiorespiratory monitoring in postoperative patients: I Prediction of outcome and severity of illness. Crit Care Med 7: 237–242PubMedCrossRefGoogle Scholar
  13. 13.
    Bland RD, Shoemaker WC, Abraham E, Cobo JC (1985) Hemodynamic and oxygen transport patterns in surviving and non-surviving patients. Crit Care Med 13: 85–90PubMedCrossRefGoogle Scholar
  14. 14.
    Shoemaker WC, Czer LSC (1979) Evaluation of the biologic importance of various hemodynamic and oxygen transport variables. Crit Care Med 7: 42–429Google Scholar
  15. 15.
    Shoemaker WC, Appel PL, Kram HB (1992) Role of oxygen debt in the development of organ failure, sepsis and death in high risk surgical patients. Chest 102: 208–215PubMedCrossRefGoogle Scholar
  16. 16.
    Shoemaker WC, Appel PL, Kram HB (1993) Hemodynamic and oxygen transport responses in survivors and non-survivors of high-risk surgery. Crit Care Med 21: 977–990PubMedCrossRefGoogle Scholar
  17. 17.
    Tilney NL, Bailey GL, Morgan AP (1973) Sequential system failure after rupture of abdominal aortic aneurysms: An unsolved problem in postoperative care. Ann Surg 178: 117–122PubMedCrossRefGoogle Scholar
  18. 18.
    Fry DE (1992) Multiple system organ failure. Mosby Year Book St. Louis, USAGoogle Scholar
  19. 19.
    Nuytinck HK, Xavier JM, Offermans W, et al (1988) Whole body inflammation in trauma patients: An autopsy study. Arch Surg 123: 1519–1524Google Scholar
  20. 20.
    Granger DN (1988) Role of xanthine oxidase and granulocytes in ischemia-reperfusion injury. Am J Physiol 24: H1268 - H1275Google Scholar
  21. 21.
    Osborn L (1990) Leukocyte adhesion to endothelium in inflammation. Cell 62: 3–6PubMedCrossRefGoogle Scholar
  22. 22.
    Babu SC, Pathanjali Sharma PV, Raciti A, et al (1980) Monitor-guided responses. Arch Surg 115: 1384–1386PubMedCrossRefGoogle Scholar
  23. 23.
    Babu SC, Shah PM, Clauss RH (1982) Unappreciated causes of ischemia in the leg. Am J Surg 144: 225–229PubMedCrossRefGoogle Scholar
  24. 24.
    Bland RD, Shoemaker WC, Shabot MM (1978) Physiologic monitoring goals for the critically ill patient. Surg Gynecol Obstet 147: 833–841PubMedGoogle Scholar
  25. 25.
    Shoemaker WC, Appel PL, Waxman K, Schwartz S, Chang P (1982) Clinical trial of survivors cardiorespiratory patterns as therapeutic goals in critically ill postoperative patients. Crit Care Med 10: 398–403PubMedCrossRefGoogle Scholar
  26. 26.
    Whittmore AD, Clowes AW, Hechtman HB, Mannick JA (1980) Aortic aneurysm repair: Reduced operative mortality associated with maintainance of optimal cardiac performance. Ann Surg 192: 414–420Google Scholar
  27. 27.
    Grindlinger GA, Vegas AM, Manny J, et al (1980) Volume loading and vasodilators in abdominal aortic aneurysmectomy. Am J Surg 139: 480–486PubMedCrossRefGoogle Scholar
  28. 28.
    Schultz RJ, Whitfield GF, LaMura JJ, Raciti A, Krishnamurthy S (1985) The role of physiologic monitoring in patients with fractures of the hip. J Trauma 25: 309–316PubMedCrossRefGoogle Scholar
  29. 29.
    Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94: 1176–1186PubMedCrossRefGoogle Scholar
  30. 30.
    Berlauk JF, Abrams JH, Gilmour IJ, et al (1991) Preoperative optimisation of cardiovascular hemodynamics improves outcome in peripheral vascular surgery. Ann Surg 214: 289–297PubMedCrossRefGoogle Scholar
  31. 31.
    Boyd O, Grounds RM, Bennett ED (1994) A randomized clinical trial of the effect of deliberate peri-operative increase in oxygen delivery on mortality in high risk surgical patients. JAMA (in press)Google Scholar
  32. 32.
    Boyd O, Grounds RM, Bennett ED (1993) The use of dopexamine hydrochloride in increase oxygen delivery peri-operatively. Anesth Analg 76: 372–376PubMedGoogle Scholar
  33. 33.
    Brown RA, Dixon J, Farmer JB, et al (1985) Dopexamine: A novel agonist at peripheral dopamine receptors and beta 2 adrenoceptors. B J Pharmac 85: 599–608Google Scholar
  34. 34.
    Smith GW, Filcek SAL (1989) Dopexamine hydrochloride: A novel dopamine receptor agonist for the acute treatment of low cardiac output states. Cardiovasc Drug Rev 7: 141–159CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1994

Authors and Affiliations

  • O. Boyd
  • R. M. Grounds
  • E. D. Bennett

There are no affiliations available

Personalised recommendations