Perioperative Maintenance of Normothermia Reduces the Incidence of Morbid Cardiac Events. A Randomized Clinical Trial

Frank, Steven M.; Fleisher, Lee A.; Breslow, Michael J.; Higgins, Michael S.; Olson, Krista F.; Kelly, Susan E.; Beattie, Charles

doi:10.1016/s0022-5347(01)63151-3

Cited by 63 publications

(91 citation statements)

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“…Patients becoming hypothermic (definition: \36°C) have been shown to have higher rates of wound infection [128,129], and earlier studies reported morbid cardiac events [130] and bleeding [131]. In recovery, there is a higher risk of shivering in patients who are hypothermic, which increases oxygen consumption at a critical time [132].…”

Section: Preventing Intraoperative Hypothermiamentioning

confidence: 99%

Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS^®) Society Recommendations

et al. 2012

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Background This review aims to present a consensus for optimal perioperative care in colonic surgery and to provide graded recommendations for items for an evidencedbased enhanced perioperative protocol. Methods Studies were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group. Results For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of goodquality trials (quality of evidence and recommendations according to the GRADE system). Conclusions Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced

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Section: Preventing Intraoperative Hypothermiamentioning

confidence: 99%

Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS^®) Society Recommendations

et al. 2012

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“…1,6,7,9,[12][13][14][15][16][17][18] The characteristics of the included studies are shown in Table I. From the 11 included studies, five were prospective.…”

Section: Resultsmentioning

confidence: 99%

A meta-analysis of intraoperative factors associated with postoperative cardiac complications

Skinner

Goga

Rodseth

et al. 2012

Southern African Journal of Anaesthesia and Analgesia

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Original Research: A meta-analysis of intraoperative factors associated with postoperative cardiac complications 186 2012;18(4) South Afr J Anaesth Analg IntroductionA recent study has shown that 5% of patients who undergo noncardiac surgery will suffer a perioperative myocardial infarction. 1 More than 11% of these patients will die within 30 days of the surgery. Preoperative cardiac risk is commonly determined with the help of risk scores and risk stratification tools, such as the Revised Cardiac Risk Index (RCRI). [2][3][4][5] These scores are of limited utility as intraoperative events that relate to the surgery itself profoundly alter this calculated cardiac risk. 6,7 If these events could be identified and their impact quantified, then surgeons and anaesthetists might be able to intervene to improve perioperative cardiac outcomes.The aim of this meta-analysis was to identify intraoperative factors that changed a patient's preoperative cardiac risk of postoperative cardiac complications. MethodA meta-analysis was conducted to identify modifiable independent intraoperative predictors of postoperative cardiac complications in studies that controlled for preoperative cardiac risk factors. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were adhered to in conducting and reporting this meta-analysis. AbstractBackground: Preoperative cardiac risk is commonly determined with the help of risk scores and risk stratification tools. This predetermined cardiac risk may be profoundly changed by intraoperative surgical events. This meta-analysis aimed to identify intraoperative factors that independently predict postoperative cardiac complications in the presence of preoperative cardiac risk factors.Method: A PubMed Central search was conducted from January 1966 to June 2010, to identify independent intraoperative predictors of postoperative cardiac complications in observational perioperative studies and randomised controlled trials which controlled for preoperative cardiac risk factors.Results: Eleven studies were identified for inclusion in this meta-analysis. Intraoperative blood transfusion [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.8-3.4] was the only independent intraoperative risk predictor identified in more than one study. Other identified independent intraoperative factors included a > 20 mmHg fall in mean arterial blood pressure for > 60 minutes (OR 3.0, 95% CI 1.8-4.9), > 30% increase in baseline systolic pressure (OR 8.0,, tachycardia in the recovery room (> 30 beats per minute from baseline for > 5 minutes) (OR 7, 95% 1.9-26), new onset atrial fibrillation (OR 6.6, 95% CI 2.5-20), hypothermia (OR 2.2, 95% CI 1.1-5) and remote ischaemic preconditioning (OR 0.22, 95% CI 0.07-0.67). None of these studies controlled for blood transfusion.Conclusion: Both surgical and haemodynamic intraoperative events significantly increased the risk of postoperative cardiac complications. Intraoperative blood transfusion has the strongest evidence that supports this finding. It is poss...

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“…By and large, the low pressure groups have also reported less post-operative pain and diminished analgesic requirement, but such was always not the case [34]. In patients with cardiac dysfunction, four nonrandomised studies have shown less haemodynamic alter- ations under low insufflation pressure [5,[36][37][38]. In the present study, a peritoneal pressure of 8 mmHg was used and this figure was arbitrarily chosen.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Cholecystectomy in Patients with Cardiac Dysfunction

et al. 2010

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Laparoscopic cholecystectomy remains the standard treatment for cholelithiasis. Ever increasing number of patients with myriad of medical illness is being treated by this technique. However, significant concern prevails among the surgical community regarding its safety in patients with cardiac co-morbidity. Patients with significant cardiac dysfunction and multiple co-morbidities were prospectively evaluated. Patients were assessed by cardiologists and anesthesiologists and laparoscopic cholecystectomy was performed. Patient demographics, details of peri-operative management and post-operative complications were studied. Between March 2005 and January 2009, 28 patients (M:F= 21:7) with mean age of 60 years (range 26-78) and having significant cardiac dysfunction had undergone laparoscopic cholecystectomy. Of these, 24 patients were in NYHA class-II, while 4 belonged to class-III. Left ventricular ejection fraction, as recorded by transthoracic echocardiography, was 20-30% in 13 (46%) patients and 30-40% in the rest 15 (54%). In addition, 13 (46%) patients had regional wall motion abnormalities, 11 (39%) patients had cardiomyopathy, 2 (7%) patients had valvular heart disease while 12 (43%) patients had prior cardiac interventions. Following laparoscopic cholecystectomy, hypertension (3), tachyarrhythmia (4) and bradycardia (1) were the commonest events encountered. One patient required laparotomy to deal with peritonitis in the immediate postoperative period and succumbed to myocardial infarction, but all other patients made an uneventful recovery. With appropriate cardiological support, laparoscopic cholecystectomy may be safely performed in patients with significant cardiac dysfunction.

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Perioperative Maintenance of Normothermia Reduces the Incidence of Morbid Cardiac Events. A Randomized Clinical Trial

Cited by 63 publications

References 0 publications

Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS^®) Society Recommendations

Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS^®) Society Recommendations

A meta-analysis of intraoperative factors associated with postoperative cardiac complications

Laparoscopic Cholecystectomy in Patients with Cardiac Dysfunction

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Perioperative Maintenance of Normothermia Reduces the Incidence of Morbid Cardiac Events. A Randomized Clinical Trial

Cited by 63 publications

References 0 publications

Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations

Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations

A meta-analysis of intraoperative factors associated with postoperative cardiac complications

Laparoscopic Cholecystectomy in Patients with Cardiac Dysfunction

Contact Info

Product

Resources

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Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS^®) Society Recommendations

Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS^®) Society Recommendations