Perioperative Care of Cardiac Risk Patients: New Pharmacological Strategies

  • P. Coriat
Conference paper


Taking into account the nature of perioperative cardiac complications and the moment when they occur during the operating period, it has become possible to define perioperative managements, which may improve the cardiac risk in patients suffering from coronary artery disease (CAD) undergoing non-cardiac surgery. The main goal of the perioperative management of patients with coronary artery disease is to control increased sympathetic tone or its circulatory effects. Two types of cardiovascular drugs have been recommended to achieve this goal: β adrenergic blocking drugs and α-2 adrenoreceptor agonists.


Coronary Artery Disease Patient Noncardiac Surgery Adrenoceptors Agonist Cardiac Morbidity Postoperative Myocardial Infarction 


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  1. 1.
    Mangano DT (1990) Perioperative cardiac morbidity (review). Anesthesiology 72:153–184PubMedCrossRefGoogle Scholar
  2. 2.
    Mangano DT, Browner WS, Hollenberg M et al (1990) Associations of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing non cardiac surgery. N Engl J Med 323:1781–1788PubMedCrossRefGoogle Scholar
  3. 3.
    McCann RL, Clements FM (1989) Silent myocardial ischemia in patients undergoing peripheral vascular surgery: Incidence and association with perioperative cardiac morbidity and mortality. J Vase Surg 9:583–587Google Scholar
  4. 4.
    Raby KE, Barry J, Creager MA et al (1992) Detection and significance of intraoperative and postoperative myocardial ischemia in peripheral vascular surgery. JAMA 268:222–227PubMedCrossRefGoogle Scholar
  5. 5.
    Landesberg G, Luria MH, Cotev S et al (1993) Importance of long-duration postoperative ST-segment depression in cardiac morbidity after vascular surgery. Lancet 341:715–719PubMedCrossRefGoogle Scholar
  6. 6.
    Mangano DT, Browner WS, Hollenberg M, Tateo IM (1992) Long term cardiac prognosis following non cardiac surgery. JAMA 268:233–239PubMedCrossRefGoogle Scholar
  7. 7.
    Adams J, Sicard A, Allen T et al (1994) Diagnosis of perioperative myocardial infarction with measurement of cardiac troponin I. N Engl J Med 330:670–674PubMedCrossRefGoogle Scholar
  8. 8.
    Metzler H, Gries M, Rehak P et al (1997) Perioperative myocardial cell injury: the role of troponins. Br J Anaesth 78:386–390PubMedCrossRefGoogle Scholar
  9. 9.
    Collins GJ, Barber JA, Zajtchuk R et al (1977) The effects of postoperative stress on the coagulation profile. Am J Surg 133:612–616PubMedCrossRefGoogle Scholar
  10. 10.
    Rosenfeld B, Beattie C, Christopherson R et al (1993) The effects of different anesthetic regimen on fibrinolysis and the development of postoperative arterial thrombosis. Anesthesiology 79:435–443PubMedCrossRefGoogle Scholar
  11. 11.
    Tarhan, Moffitt EA, Taylor WF, Giuliani ER (1972) Myocardial infarction after general anesthesia. JAMA 220:1451–1454PubMedCrossRefGoogle Scholar
  12. 12.
    Rao, Jacobs KH, Al-Etr AA (1983) Reinfarction following anesthesia in patients with myocardial infarction. Anesthesiology 59:499–505PubMedCrossRefGoogle Scholar
  13. 13.
    Goldman L (1992) Perioperative myocardial ischemia. To every thing there is a season. Anesthesiology 76:331–333PubMedCrossRefGoogle Scholar
  14. 14.
    Warltier DC (1998) Beta-adrenergic-blocking drugs: Incredibly useful, incredibly underutilized. Anesthesiology 88:2–5PubMedCrossRefGoogle Scholar
  15. 15.
    Mangano DT, Layug EL, Wallace A et al (1996) Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. N Engl J Med 335:1713–1720PubMedCrossRefGoogle Scholar
  16. 16.
    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 68:495PubMedCrossRefGoogle Scholar
  17. 17.
    Wallace A, Layug B, Tateo I et al (1998) Prophylactic atenolol reduces postoperative myocardial ischemia. Anesthesiology 88:7–17PubMedCrossRefGoogle Scholar
  18. 18.
    Longnecker DE (1987) Alpine Anesthesia. Can pretreatment with Clonidine decrease the peaks and valleys? Anesthesiology 67:1–2PubMedCrossRefGoogle 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, Viale JP, Annat G et al (1991) Oxygen uptake after major abdominal surgery: effect of Clonidine. Anesthesiology 74:236–241PubMedCrossRefGoogle Scholar
  21. 21.
    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
  22. 22.
    Delaunay L, Bonnet F, Liu N et al (1993) Clonidine comparably decreases the thermoregulatory thresholds for vasoconstriction and shivering in humans. Anesthesiology 79:470–474PubMedCrossRefGoogle Scholar
  23. 23.
    McSpi, European Research Group (1997) Perioperative sympatholysis. Anesthesiology 86: 346–363CrossRefGoogle Scholar
  24. 24.
    Jalonen J, Hynynen M, Kuitunen A et al (1997) Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology 86:331–345PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • P. Coriat
    • 1
  1. 1.Dept. of AnaesthesiaPitié-Salpêtrière HospitalParisFrance

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