sábado, 9 de junio de 2012

Tratamiento del infarto perioperatorio despues de cirugía no cardiaca


Tratamiento del infarto perioperatorio despues de cirugía no cardiaca
The treatment of perioperative myocardial infarctions following noncardiac surgery
Lisa Ryan, Reitze Rodseth, Dr Bruce Biccard
South Afr J Anaesth Analg 2012;18(2):86-93

Abstract
Background: Perioperative myocardial infarction (PMI) is a common complication following noncardiac surgery, with a 30-day mortality of 10-20%. Effective therapeutic interventions are of public health importance. Method: This is a systematic review, aimed to determine the evidence for therapies following PMI. Results: A PubMed Central search up to May 2011 identified 20 case series and reports (89 patients). We extracted data on the type and timing of treatment and short-term mortality. Short-term mortality differed significantly between haemodynamically stable and unstable patients (0% and 32.2% respectively, p-value = 0.015). Significantly more haemodynamically unstable patients received acute coronary interventions (75.8% vs. 23.1%, p-value = 0.0006). Acute coronary intervention in haemodynamically unstable patients was not associated with improved short-term survival (p-value = 0.53). The high proportion of symptomatic and haemodynamically unstable patients suggests publication bias (χ2 = 16.29, p-value = 0 < 0001 and χ2 = 154.41, p-value < 0.0001, respectively). Conclusion: This systematic review highlights the paucity of evidence for PMI management, and the need for future prospective trials.
http://www.sajaa.co.za/index.php/sajaa/article/view/878
http://www.sajaa.co.za/index.php/sajaa/article/view/878/1077  
Atentamente
Anestesiología y Medicina del Dolor

No hay comentarios: