Medical College of Wisconsin
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Approaches to the prevention of perioperative myocardial ischemia. Anesthesiology 2000 Jan;92(1):253-9

Date

01/19/2000

Pubmed ID

10638923

DOI

10.1097/00000542-200001000-00038

Scopus ID

2-s2.0-0033980389 (requires institutional sign-in at Scopus site)   148 Citations

Abstract

Goals for the perioperative management of patients with coronary artery disease include: * Prevent increases in sympathetic nervous system activity: reduce anxiety preoperatively; prevent stress response and release of catecholamines by appropriate use of opioids or volatile anesthetics and beta-adrenoceptor antagonists; beta-blocker therapy should be initiated before and continued during and after the surgical procedure. * Decrease heart rate: reduction in heart rate increases oxygen supply to ischemic myocardium and reduces oxygen demand; the use of beta-blockers is the most effective means to reduce or attenuate deleterious increases in heart rate. * Preserve coronary perfusion pressure: decreases in diastolic arterial pressure in the presence of severe coronary artery stenoses will lead to decreases in blood flow; preservation of perfusion pressure by administration of fluid or phenylephrine or a reduction in anesthetic concentration may be critical. * Decrease myocardial contractility: reduces myocardial oxygen demand and can be accomplished with beta-adrenoceptor antagonists or volatile anesthetics. * Precondition myocardium against stunning and infarction: in the future, this may accomplished by stimulating the adenosine triphosphate- dependent potassium channel with agents such as volatile anesthetics and opioid delta1-receptor agonists.

Author List

Warltier DC, Pagel PS, Kersten JR

Authors

Paul S. Pagel PhD, MS, MD Emeritus Professor in the Anesthesiology department at Medical College of Wisconsin
David C. Warltier PhD Emeritus Professor in the Anesthesiology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adrenergic beta-Antagonists
Coronary Disease
Humans
Intraoperative Complications
Myocardial Ischemia