1
|
Abstract
Perioperative cardioprotection aims to minimize the consequences of myocardial ischemia-reperfusion injury. In isolated tissue and animal experiments, several treatments have been identified providing cardioprotection. Some of these strategies have been confirmed in clinical proof-of-concept studies. However, the final translation of cardioprotective strategies to really improve clinical outcome has been disappointing: large randomized controlled clinical trials mostly revealed inconclusive, neutral, or negative results. This review provides an overview of the currently available evidence regarding clinical implications of perioperative cardioprotective therapies from an anesthesiological perspective, highlighting nonpharmacological as well as pharmacological strategies. We discuss reasons why translation of promising experimental results into clinical practice and outcome improvement is hampered by potential confounders and suggest future perspectives to overcome these limitations.
Collapse
|
3
|
Treskatsch S. Das richtigte Herz-Kreislauf-Medikament - was, wann und wie? Anaesthesist 2020; 69:779-780. [DOI: 10.1007/s00101-020-00865-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
5
|
Yeh HW, Yeh LT, Chou YH, Yang SF, Ho SW, Yeh YT, Yeh YT, Wang YH, Chan CH, Yeh CB. Risk of Cardiovascular Disease Due to General Anesthesia and Neuraxial Anesthesia in Lower-Limb Fracture Patients: A Retrospective Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010033. [PMID: 31861460 PMCID: PMC6982192 DOI: 10.3390/ijerph17010033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to analyze the relationship between elevated cardiovascular disease (CVD) risk and type of anesthesia by using the National Health Insurance Research Database (NHIRD) of Taiwan in a one-year follow-up period. We assessed whether general anesthesia (GA) or neuraxial anesthesia (NA) increased CVD occurrence in lower-limb fracture patients. Approximately 1 million patients were randomly sampled from the NHIRD registry. We identified and enrolled 3437 lower-limb fracture patients who had received anesthesia during operations conducted in the period from 2010 to 2012. Next, patients were divided into two groups, namely GA (n = 1504) and NA (n = 1933), based on the anesthetic technique received during surgery. Our results revealed that those receiving GA did not differ in their risk of CVD relative to those receiving NA, adjusted HR = 1.24 (95% CI: 0.80–1.92). Patients who received GA for more than 2 h also did not differ in their risk of CVD relative to those receiving NA for less than 2 h, adjusted HR = 1.43 (95% CI: 0.81–2.50). Moreover, in the GA group (i.e., patients aged ≥65 years and women), no significant difference for the risk of CVD events was observed. In conclusion, in our study, the difference in the risk of CVD between lower-limb fracture patients receiving NA and GA was not statistically significant. The incidence rate of CVD seemed to be more correlated with patients’ underlying characteristics such as old age, comorbidities, or admission to the intensive care unit. Due to the limited sample size in this study, a database which reviews a whole national population will be required to verify our results in the future.
Collapse
Affiliation(s)
- Han-Wei Yeh
- School of Medicine, Chang Gung University, Taoyuan City 333, Taiwan;
| | - Liang-Tsai Yeh
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (L.-T.Y.); (Y.-H.C.); (S.-F.Y.)
- Department of Anesthesiology, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Ying-Hsiang Chou
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (L.-T.Y.); (Y.-H.C.); (S.-F.Y.)
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; (L.-T.Y.); (Y.-H.C.); (S.-F.Y.)
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan;
| | - Sai-Wai Ho
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan;
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Ying-Tung Yeh
- School of Dentistry, Chung Shan Medical University, Taichung 402, Taiwan; (Y.-T.Y.); (Y.-T.Y.)
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Ying-Ting Yeh
- School of Dentistry, Chung Shan Medical University, Taichung 402, Taiwan; (Y.-T.Y.); (Y.-T.Y.)
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan;
| | - Chi-Ho Chan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan;
- Department of Microbiology and Immunology, Chung Shan Medical University, Taichung 402, Taiwan
- Correspondence: (C.-H.C.); (C.-B.Y.)
| | - Chao-Bin Yeh
- Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan;
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: (C.-H.C.); (C.-B.Y.)
| |
Collapse
|
6
|
Princk M, Wnent J, Maurer H. [72-year-old male with arrhythmia during surgery : Preparation for the medical specialist examination: Part 45]. Anaesthesist 2019; 68:288-291. [PMID: 31624877 DOI: 10.1007/s00101-019-00651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | - H Maurer
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| |
Collapse
|