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Riassunto

Una gestione corretta della fase perioperatoria del paziente con coronaropatia non può prescindere dalla completa conoscenza della fisiopatologia dell’ischemia miocardica.

Una pedissequa applicazione delle linee guida internazionali in argomento non consente infatti all’anestesista di adattare la propria condotta alle problematiche del singolo paziente.

Le linee guida propongono consigli generali, ma solo conoscendo a fondo i meccanismi alla base degli eventi ischemici è possibile prevenirli; solo disponendo di una sufficiente cultura dei mezzi di controllo possiamo tempestivamente diagnosticarli; solo se ci è ben nota la farmacocinetica e la farmacodinamica dei farmaci che utilizziamo siamo in grado di trattarli.

L’obiettivo di questo capitolo è quindi quello di contribuire alla conoscenza della fisiopatologia dell’ischemia e, partendo da essa, di guidare alla condotta di prevenzione, diagnosi e trattamento.

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Bibliografia

  • American Society of Anethesiologists Committee on Standards and Practice Parameters (2009) Practice alert for the perioperative management of patients with coronary artery stents. Anesthesiology 110:22–23

    Article  Google Scholar 

  • Behar S, Panosh A et al (1992) Prevalence and prognosis of COPD among 5839 consecutive patients with acute myocardial infarction. SPRINT Study Group. Am J Med 93:637

    Article  CAS  PubMed  Google Scholar 

  • Deveraux PJ, Yang H, Yusuf S et al (2008) Effects of extended-release metoprolol succinal in patiens undergoing non cardiac surgery (POISE trial): a randomized controlled trial. Lancet 371:1839–1847

    Article  Google Scholar 

  • Ferro KE, Muhlmann MH, Baguet JP et al (1995) Relation between diastolic perfusion time and coronary artery stenosis during stress-induced myocardial ischemia. Circulation 92:342–347

    CAS  PubMed  Google Scholar 

  • Fleischer LA, Beckman JA, Brown KA et al (2007) ACC/AHA Guidelines on perioperative cardiovascular evaluation and care for non cardiac surgery. J Am Coll Cardiol 50:c159

    Article  Google Scholar 

  • Fleisher LA, Beckman JA, Brawn KA et al (2007) ACC/AHA Guidelines on perioperative cardiovascular evaluation and care for non cardiac surgery: Executive summary. Circulation 116:1971–1996

    Article  PubMed  Google Scholar 

  • Fox K, Garcia MA, Ardinino D et al (2006) Task force on the management of stable angina pectoris of the European Society of Cardiology. ESC Committee for practice guidelines. Eur Heart J 27:1341–1381

    Article  PubMed  Google Scholar 

  • Furberg CD, Psaty BM, Meyer JV (1995) Nifedipine dose related increase in mortality in patients with coronary artery disease. Circulation 92:1326–1331

    CAS  PubMed  Google Scholar 

  • Hjart LE, Suissa S (2005) Cardiovacular morbidity and mortality in COPD. Chest 128:2640

    Article  Google Scholar 

  • Landsberg G, Shatz V et al (2003) Association of cardiac troponin, CK-MB and postoperative myocardial ischemia with long-term survival after major vascular surgery. J Am Coll Cardiol 42:1547–1554

    Article  Google Scholar 

  • Lee TH, Marcantonio ER, Mangione CM et al (1999) Derivation and prospective validation of a simple index for prediction of cardiac risk of major non cardiac surgery. Circulation 100:1043–1049

    CAS  PubMed  Google Scholar 

  • Lindal B, Tors H et al (2000) Markers of myocardial damage and inflammation in relation to longterm mortality in unstable coronary artery disease. New Engl J Med 343–347

    Google Scholar 

  • Mangano DT, Layng FC, Wallace A et al (1996) Effect of atenolol on mortality and cardiovascular morbidity after non cardiac surgery. Multicenter study of perioperative ischemia research group. N Engl J Med 335:1713–1720

    Article  CAS  PubMed  Google Scholar 

  • Melling AC, Ali B, Scott FM et al (2001) Effects of preoperative warning on the incidence of wound infection after clean surgery: a randomized controlled trial. Lancet 358:876–880

    Article  CAS  PubMed  Google Scholar 

  • Michard F (2005) Changes in arterial pressure during mechanical ventilation. Anesthesiology 103:419–428

    Article  PubMed  Google Scholar 

  • Nichols WW, O’Rouske MF, Mc Donald’s A (2005) Blood flow in arteries, 5th edn, Oxford University Press, Oxford, p 435–450

    Google Scholar 

  • O’Donoghue M, Morrow DA (2008) The future of biomarkers in the management of patients with the acute coronary syndrome. Curr Opin in Cardiol 23:309–314

    Article  Google Scholar 

  • Omland T, Delemos JA et al (2009) A sensitive cardiac troponin T essay in stable coronary artery disease. N Engl J Med 361:2538–2547

    Article  CAS  PubMed  Google Scholar 

  • Poldermans D, Boeroma E, Bax JJ et al (1999) The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch echocardiographic cardiac risk evaluation applying stress echocardiography Study Group. N Engl J Med 341:1789–1794

    Article  CAS  PubMed  Google Scholar 

  • Reynolds RJ, Buford JG et al (1982) Treating asthma and COPD in patients with heart disease. J Resp Dis 3:41

    Google Scholar 

  • Riesmeier A, Schellhaass A, Boldt J et al (2009) Crystalloid/colloid versus crystalloid intravascular volume administration before spinal anesthesia in elderly patients: the influence on cardiac output and stroke volume. Anesth Analg 108:650–654

    Article  CAS  PubMed  Google Scholar 

  • Rodseth RN, Padayachee L, Riccard M (2008) A meta-analysis of the utility of preoperative BNP in predicting early and intermediate-term mortality and major adverse cardiac events in vascular surgical patients. Anesthesia 63:1226–1330

    Article  CAS  Google Scholar 

  • Sear JW, Giles JW, Howard-Alpe G et al (2008) Perioperative beta blocked 2008. What does POISE tell us, and was our earlier caution justified? Brit J Anaesth 101:135–136

    Article  CAS  PubMed  Google Scholar 

  • Sha Mr, Hasselblad V et al (2005) Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA 294:1664

    Article  Google Scholar 

  • Shave RG, Atkinson G et al (2007) Exercise-induced cardiac troponin T release: a meta-analysis. Med Sci Sports Exerc 39: 2099–2106

    Article  CAS  PubMed  Google Scholar 

  • Sicari R, Nihiymopoulos P, Evangelista A et al (2009) Stress echocardiography expert Consensus Statement-Executive summary. Eur Heart J 30:278–289

    Article  PubMed  Google Scholar 

  • Slogoff S, Keats AS, David Y et al (1990) Incidence of perioperative myocardial ischemia detected by Different Electrocardiographic Systems. Anesthesiology 73:1074–1081

    Article  CAS  PubMed  Google Scholar 

  • Thomas SJ, Lowenstein E (1979) Anaesthetic management of the patient with valvular heart disease. Int Anesthesiol Clin 17:67–75

    Article  CAS  PubMed  Google Scholar 

  • Tricoci P, Allen JM, Kramer JM et al (2009) Scientific evidence underlying the ACC/AHA clinical practice guidelines. JAMA 301:831–841

    Article  CAS  PubMed  Google Scholar 

  • Zorko N, Kamenik M, Starc U (2009) The effect of Trendelenburg position, lactated Ringer’s solution and 6% HRS solution on cardiac output after spinal anaesthesia. Anesth Analg 108:655–659

    Article  CAS  PubMed  Google Scholar 

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Allaria, B. (2011). Il monitoraggio delle funzioni vitali nel perioperatorio del coronaropatico. In: Allaria, B., Dei Poli, M. (eds) Il monitoraggio delle funzioni vitali nel perioperatorio non cardiochirurgico. Springer, Milano. https://doi.org/10.1007/978-88-470-1723-8_3

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  • DOI: https://doi.org/10.1007/978-88-470-1723-8_3

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