Advertisement

Optimization of the Perioperative Period in High-Risk Patients

  • A. F. Hammerle
  • C. Tatschl
Conference paper

Abstract

Cardiovascular complications, respiratory events and allergic reactions represent the most frequent adverse events in patients undergoing surgery and anaesthesia [1, 2].

Keywords

Noncardiac Surgery Natural Rubber Latex High Risk Surgical Patient Ischaemic Precondition Latex Allergy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Mangano DT (1990) Perioperative cardiac morbidity. Anesthesiology 72:153–184PubMedCrossRefGoogle Scholar
  2. 2.
    Ouchterlony J, Arvidsson S, Sjostedt L et al (1995) Perioperative and immediate postoperative adverse events in patients undergoing elective general and orthopaedic surgery. The Gothenburg study of perioperative risk (PROPER). Part II. Acta Anaesthesiol Scand 39: 643–652PubMedCrossRefGoogle Scholar
  3. 3.
    Dripps RD (1963) New classification of physical status. Anesthesiology 24:111Google Scholar
  4. 4.
    Goldman L, Caldera DL, Nussbaum SR et al (1977) Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 297:845–850PubMedCrossRefGoogle Scholar
  5. 5.
    Detsky AS, Abrams HB, McLaughlin JR et al (1986) Predicting cardiac complications in patients undergoing non cardiac surgery. Gen Intern Med 1:211–219CrossRefGoogle Scholar
  6. 6.
    Prause G, Ratzenhofer-Comenda B, Pierer G et al (1997) Can ASA grade or Goldman’s cardiac risk index predict perioperative mortality? A study of 16,227 patients. Anaesthesia 52: 203–206PubMedCrossRefGoogle Scholar
  7. 7.
    Eagle KA, Brundage BH, Chaitman BR et al (1996) Guidelines for perioperative cardiovascular evaluation for noncardiac surgery. Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). J Am Coll Cardiol 27:910–948PubMedCrossRefGoogle Scholar
  8. 8.
    Guidelines for assessing and managing the perioperative risk from coronary artery disease associated with major noncardiac surgery (1997) American College of Physicians. Ann Intern Med 127:309–312Google Scholar
  9. 9.
    Palda VA, Detsky AS (1997) Perioperative assessment and management of risk from coronary artery disease. Ann Intern Med 127:313–328PubMedGoogle Scholar
  10. 10.
    Berlauk JF, Abrams JH, Gilmour IJ et al (1991) Preoperative optimization of cardiovascular hemodynamics improves outcome in peripheral vascular surgery. A prospective, randomized clinical trial. Ann Surg 14:289–297CrossRefGoogle Scholar
  11. 11.
    Sinclair S, James S, Singer M (1997) Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. BMJ 315:909–912PubMedCrossRefGoogle Scholar
  12. 12.
    Boyd O, Grounds RM, Bennett ED (1993) A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high risk surgical patients. JAMA 270:2699–2707PubMedCrossRefGoogle Scholar
  13. 13.
    Guest JF, Boyd O, Hart WM et al (1997) A cost analysis of a treatment policy of a deliberate perioperative increase in oxygen delivery in high risk surgical patients. Intensive Care Med 23:85–90PubMedCrossRefGoogle Scholar
  14. 14.
    Roizen MF (1988) Should we all have a sympathectomy at birth? Or at least preoperatively? Anesthesiology 68:482–484PubMedCrossRefGoogle Scholar
  15. 15.
    Nicolaou G, Chen AA, Johnston CE et al (1997) Clonidine decreases vasoconstriction and shivering thresholds, without affecting the sweating threshold. Can J Anaesth 44:636–642PubMedCrossRefGoogle Scholar
  16. 16.
    Vanderstappen I, Vandermeersch E, Vanacker B et al (1996) The effect of prophylactic Clonidine on postoperative shivering. A large prospective double blind study. Anaesthesia 51: 351–355PubMedCrossRefGoogle Scholar
  17. 17.
    Horn EP, Werner C, Sessler DI et al (1997) Late intraoperative Clonidine administration prevents postanesthetic shivering after total intravenous or volatile anesthesia. Anesth Analg 84:613–617PubMedGoogle Scholar
  18. 18.
    Quintin L, Bonnet F, Macquin I et al (1990) Aortic surgery: effect of Clonidine on intraoperative catecholaminergic and circulatory stability. Acta Anaesthesiol Scand 34:132–137PubMedCrossRefGoogle Scholar
  19. 19.
    Ellis JE, Drijvers G, Pedlow S et al (1994) Premedication with oral and transdermal Clonidine provides safe and efficacious postoperative sympatholysis. Anesth Analg 79:1133–1140PubMedCrossRefGoogle Scholar
  20. 20.
    Quintin L, Bouilloc X, Butin E et al (1996) Clonidine for major vascular surgery in hypertensive patients: a double blind, controlled, randomized study. Anesth Analg 83:687–695PubMedGoogle Scholar
  21. 21.
    Zhang X, Wulfert E, Hanin I (1997) Mivazerol, a new alpha 2 adrenergic agonist, blunts cardiovascular effects following surgical stress in pentobarbital anesthetized rats. Acta Anaesthesiol Scand 41:694–700PubMedCrossRefGoogle Scholar
  22. 22.
    Guyaux M, Gobert J, Noyer M et al (1998) Mivazerol prevents the tachycardia caused by emergence from halothane anesthesia partly through activation of spinal alpha 2 adrenoceptors. Acta Anaesthesiol Scand 42:238–245PubMedCrossRefGoogle Scholar
  23. 23.
    Bruandet N, Rentero N, Debeer L et al (1998) Catecholamine activation in the vasomotor center on emergence from anesthesia: the effects of alpha 2 agonists. Anesth Analg 86: 240–245PubMedGoogle Scholar
  24. 24.
    Richer C, Gobert J, Noyer M et al (1996) Peripheral alpha 2 adrenoceptor mediated sympa-thoinhibitory effects of mivazerol. Fundam Clin Pharmacol 10:529–537PubMedCrossRefGoogle Scholar
  25. 25.
    McSPI Europe Research Group (1997) Perioperative sympatholysis. Beneficial effects of the alpha 2 adrenoceptor agonist mivazerol on hemodynamic stability and myocardial ischemia. Anesthesiology 86:346–363CrossRefGoogle Scholar
  26. 26.
    Stone JG, Foex P, Sear JW et al (1988) Myocardial ischemia in untreated hypertensive patients: effect of a single small oral dose of a beta adrenergic blocking agent. Anesthesiology 68:495–500PubMedCrossRefGoogle Scholar
  27. 27.
    Mangano DT, Layug EL, Wallace A et al (1996) Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med 335:1713–1720PubMedCrossRefGoogle Scholar
  28. 28.
    Wallace A, Layug B, Tateo I et al (1998) Prophylactic atenolol reduces postoperative myocardial ischemia. McSPI Research Group. Anesthesiology 88:7–17PubMedCrossRefGoogle Scholar
  29. 29.
    Hannes W, Seitelberger R, Christoph M et al (1995) Effect of perioperative diltiazem on myocardial ischaemia and function in patients receiving mammary artery grafts. Eur Heart J 16: 87–93PubMedCrossRefGoogle Scholar
  30. 30.
    Malhotra R, Mishra M, Kler TS et al (1997) Cardioprotective effects of diltiazem infusion in the perioperative period. Eur J Cardiothorac Surg 12:420–427PubMedCrossRefGoogle Scholar
  31. 31.
    Podesser BK, Schwarzacher S, Zwoelfer W et al (1995) Comparison of perioperative myocardial protection with nifedipine versus nifedipine and metoprolol in patients undergoing elective coronary artery bypass grafting. J Thorac Cardiovasc Surg 110:1461–1469PubMedCrossRefGoogle Scholar
  32. 32.
    Boldt J, Rothe G, Schindler E et al (1996) Can Clonidine, enoximone, and enalaprilat help to protect the myocardium against ischaemia in cardiac surgery? Heart 76:207–213PubMedCrossRefGoogle Scholar
  33. 33.
    Frank SM, Higgins MS, Breslow MJ et al (1995) The catecholamine, Cortisol, and hemodynamic responses to mild perioperative hypothermia. A randomized clinical trial. Anesthesiology 82:83–93PubMedCrossRefGoogle Scholar
  34. 34.
    Frank SM, Fleisher LA, Breslow MJ et al (1997) Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA 277: 1127–1134PubMedCrossRefGoogle Scholar
  35. 35.
    Murry CE, Jennings RB, Reimer KA (1986) Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 74:1124–1136PubMedCrossRefGoogle Scholar
  36. 36.
    Kuzuya T, Hoshida S, Yamashita N et al (1993) Delayed effects of sublethal ischemia on the acquisition of tolerance to ischemia. Circ Res 72:1293–1299PubMedCrossRefGoogle Scholar
  37. 37.
    Okazaki Y, Kodama K, Sato H et al (1993) Attenuation of increased regional myocardial oxygen consumption during exercise as a major cause of warm up phenomenon. J Am Coll Cardiol 21:1597–1604PubMedCrossRefGoogle Scholar
  38. 38.
    Deutsch E, Berger M, Kussmaul WG et al (1990) Adaptation to ischemia during percutaneous transluminal coronary angioplasty. Clinical, hemodynamic, and metabolic features. Circulation 82:2044–2051PubMedCrossRefGoogle Scholar
  39. 39.
    Kloner RA, Shook T, Przyklenk K et al (1995) Previous angina alters in hospital outcome in TIMI4. A clinical correlate to preconditioning? Circulation 91:37–45PubMedCrossRefGoogle Scholar
  40. 40.
    Lu EX, Chen SX, Hu TH et al (1998) Preconditioning enhances myocardial protection in patients undergoing open heart surgery. Thorac Cardiovasc Surg 46:28–32PubMedCrossRefGoogle Scholar
  41. 41.
    Illes RW, Swoyer KD (1998) Prospective, randomized clinical study of ischemic preconditioning as an adjunct to intermittent cold blood cardioplegia. Ann Thorac Surg 65:748–752PubMedCrossRefGoogle Scholar
  42. 42.
    Liu GS, Thornton J, Van Winkle DM et al (1991) Protection against infarction afforded by preconditioning is mediated by Al adenosine receptors in rabbit heart. Circulation 84: 350–356PubMedCrossRefGoogle Scholar
  43. 43.
    Auchampach JA, Grover GJ, Gross GJ (1992) Blockade of ischaemic preconditioning in dogs by the novel ATP dependent potassium channel antagonist sodium 5-hydroxydecanoate. Cardiovasc Res 26:1054–1062PubMedCrossRefGoogle Scholar
  44. 44.
    Mentzer RM Jr, Rahko PS, Molina-Viamonte V et al (1997) Safety, tolerance, and efficacy of adenosine as an additive to blood cardioplegia in humans during coronary artery bypass surgery. Am J Cardiol 79:38–43PubMedCrossRefGoogle Scholar
  45. 45.
    Brooks-Brunn JA (1997) Predictors of postoperative pulmonary complications following abdominal surgery. Chest 111:564–571PubMedCrossRefGoogle Scholar
  46. 46.
    Nunn JF, Milledge JS, Chen D et al (1988) Respiratory criteria of fitness for surgery and anaesthesiology. Anaesthesia 43:543–551PubMedCrossRefGoogle Scholar
  47. 47.
    Kheradmand F, Wiener-Kronish JP, Corry DB (1997) Assessment of operative risk for patients with advanced lung disease. Clin Chest Med 18:483–494PubMedCrossRefGoogle Scholar
  48. 48.
    Warner DO, Warner MA, Barnes RD et al (1996) Perioperative respiratory complications in patients with asthma. Anesthesiology 85:460–467PubMedCrossRefGoogle Scholar
  49. 49.
    May HA, Smyth RL, Romer HC et al (1996) Effects of anaesthesia on lung function in children with asthma. Br J Anaesth 77:200–202PubMedCrossRefGoogle Scholar
  50. 50.
    Cheney FW, Posner KL, Caplan RA (1991) Adverse respiratory events infrequently leading to malpractice suits. A closed claims analysis. Anesthesiology 75:932–939PubMedCrossRefGoogle Scholar
  51. 51.
    Pizov R, Brown RH, Weiss YS et al (1995) Wheezing during induction of general anesthesia in patients with and without asthma. A randomized, blinded trial. Anesthesiology 82: 1111–1116PubMedCrossRefGoogle Scholar
  52. 52.
    Hirota K, Hashimoto Y, Sakai T et al (1998) In vivo spasmolytic effect of ketamine and adrenaline on histamine-induced airway constriction. Direct visualization method with a superfine bronchoscope. Acta Anaesthesiol Scand 42:184–188PubMedCrossRefGoogle Scholar
  53. 53.
    Jahangir SM, Islam F, Aziz L (1993) Ketamine infusion for postoperative analgesia in asthmatics: a comparison with intermittent meperidine. Anesth Analg 76:45–49PubMedCrossRefGoogle Scholar
  54. 54.
    Erskine RJ, Murphy PJ, Langton JA (1994) Sensitivity of upper airway reflexes in cigarette smokers: effect of abstinence. Br J Anaesth 73:298–302PubMedCrossRefGoogle Scholar
  55. 55.
    Schwilk B, Bothner U, Schraag S et al (1997) Perioperative respiratory events in smokers and nonsmokers undergoing general anaesthesia. Acta Anaesthesiol Scand 41:348–355PubMedCrossRefGoogle Scholar
  56. 56.
    Rezaiguia S, Jayr C (1996) Prevention of respiratory complications after abdominal surgery. Ann Fr Anesth Reanim 15:623–646PubMedCrossRefGoogle Scholar
  57. 57.
    Laxenaire MC (1993) Drugs and other agents involved in anaphylactic shock occurring during anaesthesia. A French multicenter epidemiological inquiry. Ann Fr Anesth Reanim 12: 91–96PubMedCrossRefGoogle Scholar
  58. 58.
    Vasallo SA (1998) Perioperative care of latex-allergic patients. In: Lake CL, Rice LJ, Sperry JS (eds) Advances in anesthesia vol. 15. Mosby, St. Louis, pp 107–131Google Scholar
  59. 59.
    Meeropol E, Kelleher R, Bell S et al (1990) Allergic reactions to rubber in patients with myelodysplasia. N Eng J Med 323:1072Google Scholar
  60. 60.
    Theissen U, Theissen JL, Mertes N et al (1997) IgE-mediated hypersensitivity to latex in childhood. Allergy 52:665–669PubMedCrossRefGoogle Scholar
  61. 61.
    Brehler R, Theissen U, Mohr C et al (1997) “Latex-fruit syndrome”: frequency of cross-reacting IgE antibodies. Allergy 52:404–410PubMedCrossRefGoogle Scholar
  62. 62.
    Turjanmaa K, Palosuo T, Alenius H et al (1997) Latex allergy diagnosis: in vivo and in vitro standardization of a natural rubber latex extract. Allergy 52:41–50PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • A. F. Hammerle
    • 1
  • C. Tatschl
    • 1
  1. 1.Dept. of Anaesthesia and General Intensive Care MedicineUniversity of ViennaAustria

Personalised recommendations