RT Book, Section
A1 Hayes, Tom
A2 Freeman, Brian S.
A2 Berger, Jeffrey S.
SR Print(0)
ID 1135739867
T1 Perioperative Myocardial Ischemia
T2 Anesthesiology Core Review: Part Two Advanced Exam
YR 2016
FD 2016
PB McGraw-Hill Education
PP New York, NY
SN 9781259641770
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1135739867
RD 2024/04/19
AB Myocardial  ischemia  and  myocardial  infarction  are  frequent  causes  of  death  in  the  30  day  period  following  noncardiac  surgery.  Several  studies  have  revealed  that  most  myocardial  ischemia  events  occur  in  the  first  48  hours  after  surgery,  most  patients  are  asymptomatic,  and  perioperative  myocardial  ischemia  is  associated  with  a  poor  prognosis.  The  perioperative  period  is  associated  with  a  prothrombotic,  inflammatory  state  characterized  by  increased  levels  of  fibrinogen  and  C-reactive  protein,  increasing  the  risk  of  myocardial  infarction.  Although  plaque  rupture  and  subsequent  coronary  artery  thrombus  formation  is  the  most  common  overall  cause  of  myocardial  infarction  in  nonsurgical  patients,  it  is  not  the  only  mechanism  of  myocardial  ischemia  in  the  perioperative  period.  The  influences  of  anesthetic  drugs  and  the  physiologic  stressors  of  surgery  may  cause  a  mismatch  in  myocardial  oxygen  supply  and  demand  that  leads  to  myocardial  ischemia.  Regardless  of  whether  the  etiology  of  perioperative  myocardial  ischemia  is  plaque  rupture  or  myocardial  oxygen  imbalance,  the  management  of  myocardial  ischemia  in  this  population  should  take  into  consideration  the  physiological  principles  of  myocardial  oxygen  supply  and  demand,  as  well  as  the  limitations  placed  on  the  use  of  traditional  antithrombotic  therapy  protocols  in  patients  undergoing  surgical  procedures.