Hemodynamic Control and Clinical Outcomes in the Perioperative Setting
2011; Elsevier BV; Volume: 25; Issue: 3 Linguagem: Inglês
10.1053/j.jvca.2011.01.018
ISSN1532-8422
AutoresSolomon Aronson, Joseph Varón,
Tópico(s)Blood Pressure and Hypertension Studies
ResumoDEATH FROM anesthesia has become rare. Worldwide, the mortality caused by general anesthesia is now estimated in the range of 0.5 to 28 per 10,000 anesthetics, with the highest mortality rates reported by clinical investigators from developing countries. 1 Braz L.G. Braz D.G. Cruz D.S. et al. Mortality in anesthesia: A systematic review. Clinics (Sao Paulo). 2009; 64: 999-1006 Crossref PubMed Scopus (20) Google Scholar , 2 Arbous M.S. Grobbee D.E. van Kleef J.W. et al. Mortality associated with anaesthesia: A qualitative analysis to identify risk factors. Anaesthesia. 2001; 56: 1141-1153 Crossref PubMed Scopus (135) Google Scholar In contrast, morbid events related to anesthetic care are more prevalent and difficult to classify. Hemodynamic changes may signal morbid events during anesthesia. A decrease in blood pressure (BP), enabling the detection of an occult hemorrhage, is an obvious example of how hemodynamic monitoring contributes to the diagnosis of a morbid state; however, monitoring for BP variability outside acceptable target thresholds, because it may contribute to postoperative 30-day mortality, is a much more subtle example. It is estimated that 500 million surgeries will be performed worldwide annually by the year 2050, with approximately 2% of these in patients at high risk for the development of cardiovascular complications. 3 Mangano D.T. Peri-operative cardiovascular morbidity: New developments. Baillieres Clin Anaesthesiol. 1999; 13: 335-348 Google Scholar In the United States alone, 30 million noncardiac surgical procedures are performed annually, 4 Mangano D.T. Layug E.L. Wallace A. et al. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med. 1996; 335: 1713-1720 Crossref PubMed Scopus (1228) Google Scholar and 2.5% to 10% of these procedures are associated with perioperative cardiovascular morbidity and mortality. 5 Basali A. Mascha E.J. Kalfas I. et al. Relation between perioperative hypertension and intracranial hemorrhage after craniotomy. Anesthesiol. 2000; 93: 48-54 Crossref PubMed Google Scholar Prospective and retrospective analyses have identified patient- and treatment-related factors (Table 1) that increase the risk for perioperative complications, including mortality, myocardial infarction (MI), stroke, acute kidney injury, pulmonary embolism, atrial fibrillation, and excessive bleeding. 3 Mangano D.T. Peri-operative cardiovascular morbidity: New developments. Baillieres Clin Anaesthesiol. 1999; 13: 335-348 Google Scholar , 6 Aronson S. Boisvert D. Lapp W. Isolated systolic hypertension is associated with adverse outcomes from coronary artery bypass grafting surgery. 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