Our study of 100 major vascular and renal transplant patients evaluated the 6-minute walk test (6MWT) as an indicator of perioperative myocardial injury, using troponin as a marker. Using logistic regression and the area under the receiving operator characteristic curve, we compared the 6MWT to the Revised Cardiac Risk Index and metabolic equivalents. Only the 6MWT was associated with elevated postoperative troponins (95% CI, 0.98-0.99). However, the 6MWT area under the receiving operator characteristic curve (0.71 [95% CI, 0.57-0.85]) was not different from the Revised Cardiac Risk Index (P = .23) or metabolic equivalents (P = .14). The 6MWT may have a role in cardiac risk stratification in the perioperative setting.
Cardiac arrhythmias are a common cause of patient morbidity and mortality. Modern electrophysiology (EP) procedures, including placement of permanent pacemakers and implantable cardioverter-defibrillators and catheter ablation of cardiac arrhythmias, have been shown to reduce mortality and improve quality of life and symptoms. These procedures can also reduce the need for antiarrhythmic medications and hence reduce side effects related to these medicines. The procedures performed in the EP laboratory can be protracted and painful and therefore frequently require the assistance of an anesthesia team for patient comfort. Additionally, this patient population often presents with complicated comorbid conditions and hemodynamic instability. Frequently, the anesthetic management can be complicated and difficult, requiring a thorough understanding of these patients and the procedures they choose to undergo.
Hypoglycemia is a frequent problem encountered with diabetics and hospitalized patients. Although point-of-care glucose meters have revolutionized management, there are circumstances wherein glucose meter readings are inaccurate. One such example of glucose meter error occurred in a patient with end-stage renal disease receiving peritoneal dialysis who underwent renal transplantation. After surgery, the patient's laboratory testing reflected hypoglycemia, while point-of-care glucose meter testing indicated hyperglycemia. It is important to remember that the "gold standard" is the laboratory serum glucose test, and if a discrepancy from point-of-care results occurs, an investigation should be made to ascertain the reason.
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