Riesgo cardiaco y anestesia.

Disfunción diastólica, envejecimiento cardiovascular, y el anestesiólogo


Diastolic dysfunction, cardiovascular aging, and the anesthesiologist.
Sanders D, Dudley M, Groban L.
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1009, USA.
Anesthesiol Clin. 2009 Sep;27(3):497-517.
Abstract
As the number of persons aged 65 years and older continues to increase, the anesthesiologist will more frequently encounter this demographic. Cardiovascular changes that occur in this patient population present difficult anesthetic challenges and place these patients at high risk of perioperative morbidity and mortality. The anesthesiologist should be knowledgeable about these age-related cardiovascular changes, the pathophysiology underlying them, and the appropriate perioperative management. Whether presenting for cardiac or general surgery, the anesthesiologist must identify patients with altered physiology as a result of aging or diastolic dysfunction and be prepared to modify the care plan accordingly. With a directed preoperative assessment that focuses on certain aspects of the cardiovascular system, and the assistance of powerful echocardiographic tools such as tissue Doppler, this can be achieved.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771111

/pdf/nihms132190.pdf





Historia cardiaca y riesgo de complicaciones cardiacas post cistectomía
Cardiac history and risk of post-cystectomy cardiac complications.
Fisher MB, Svatek RS, Hegarty PK, McGinniss JE, Hightower C, Grossman HB, Kamat AM, Dinney CP, Matin SF.
Department of Urology, MD Anderson Cancer Center, The University of Texas, Texas 77030, USA.
Urology. 2009 Nov;74(5):1085-9. Epub 2009 Sep 16.
Abstract
OBJECTIVES: To evaluate risk factors for postoperative cardiac complications (POCC). Patients undergoing cystectomy often have significant baseline cardiac disease. Despite preoperative medical optimization, postoperative cardiac complications remain a significant source of morbidity. METHODS: A retrospective review of all radical cystectomies for bladder cancer between January 2004 and September 2006 was performed. Twelve preoperative risk factors were evaluated, including age, Charlson Comorbidity Index, type of urinary diversion, and previous cardiac history. All complications, including myocardial infarction (MI) and new onset arrhythmia, were recorded for 90 days postoperatively. Univariate and multivariate analysis were performed. RESULTS: A total of 283 patients underwent cystectomy for bladder cancer between January/2004 and September 2006. The median age of the cohort was 70 (35-90) years. Of 283 patients, 64 (23%) had a significant preoperative cardiac history, including 18 (6%) with prior coronary artery bypass and 30 (11%) with a history of MIs. Thirty-one (11%) patients had either new onset arrhythmia (22, 8%) or MI (10, 4%) and 1 had both. On univariate analysis, cardiac history, age, type of urinary diversion, and the Charlson Comorbidity Index demonstrated significance. The risk of POCC was associated with ileal conduit urinary diversion (P = .026, OR 5.58 [1.23-25.36]) and the Charlson Index score (P = .030, OR 1.28 [1.024-1.60]) on multivariate analysis.CONCLUSIONS: Multiple, inter-related factors may predict cardiac complications in the early postoperative period. Despite perioperative optimization, patients with a prior cardiac history should be counseled, regarding the increased risk of postoperative cardiac complications. The association between cardiac complications and ileal conduit diversion highlights the selection bias toward patients with preexisting comorbid disease.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2784244/pdf/nihms145836.pdf










Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org