Myocardial Infarction After General Anesthesia

Abstract

During 1967 and 1968, a total of 32,877 patients had general anesthesia at the Mayo Clinic; 422 had previous myocardial infarction. Of these 6.6% experienced another infarction during the first postoperative week. There was no relationship between incidence of postoperative reinfarction and type or duration of anesthesia. However, operations on the thorax and upper abdomen were followed by three times as many reinfarctions as operations at other sites. Patients who were operated on within three months of infarction had a 37% reinfarction rate. This rate decreased to 16% in patients at three to six months after infarction, and remained at 4% to 5% when infarction had occurred more than six months previously. A significantly higher number of myocardial infarctions occurred during the third postoperative day.

ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery—Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)

“…This definition reflects the consensus of the ACC Cardiovascular Database Committee. In this way, the separation of MI into the traditional 3-and 6-month intervals has been avoided (6,15). Current management of MI provides for risk stratification during convalescence (16).…”

Postoperative Myocardial Reinfarction Following Lumbar Spine Surgery

“…MI indicates myocardial infarction; NA, not applicable. Patients were stratified into 5 groups: those who experienced an initial MI 0-3 months before undergoing lumbar surgery (0-3), those who experienced an initial MI 4-6 months before undergoing lumbar surgery (4-6), those who experience an initial MI 7-12 months before surgery (7)(8)(9)(10)(11)(12), those who experienced an initial MI 13-24 months before undergoing lumbar surgery (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), and those who experienced an initial MI 25+ months before undergoing lumbar surgery. MI indicates myocardial infarction; NA, not applicable.…”

“…6 While large cohort studies have demonstrated that 0.1%-0.7% of patients experience MI after surgery, 7,8 1-week postoperative reinfarction rates have been documented at rates around 7%. 9,10 Furthermore, Topkins and Artusio 8 demonstrated that patients experiencing a postoperative infarction had a mortality rate of 26.5% while patients experiencing a postoperative reinfarction had a mortality rate of 70%.…”

“…Several studies have demonstrated a strong temporal pattern between postoperative reinfarction rate and the period between previous MI and surgery, exhibiting an increase in postoperative reinfarction rate in patients undergoing surgery closer to the date of their initial MI. 9,11,12 Tarhan and colleagues looked at a group of patients with a history of previous MI who underwent spinal surgery, however, limited conclusions could be drawn due to the small sample size. The study included a subset of 16 patients who underwent vertebral column surgery with only 1 patient experiencing a postoperative myocardial reinfarction.…”

Quo Vadis Anesthesiologist? The Value Proposition of Future Anesthesiologists Lies in Preserving or Restoring Presurgical Health after Surgical Insult

“…The drop in mortality is so profound that studies investigating anesthesia mortality are virtually impossible, with most of the current data published in case series or audits of legal cases [10][11][12]. A decrease in intra-operative morbidity accompanies decreased mortality [12][13][14][15][16][17]. The next milestone for anesthesia in developed countries is debatable, but minimizing maladaptive allostatic sequela after peri-surgical stress seems impactful, achievable, and uniquely positioned to be pursued by next generation of anesthesiologists (Figure 1).…”