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Perioperative Pharmacological Cardiac Protection

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Thoraco-Abdominal Aorta

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Abstract

International guidelines suggest how to reduce perioperative myocardial infarction in non-cardiac surgery. Unfortunately, extensive research of the literature demonstrates that, until now, no randomized trial can be considered powerful enough to show that a specific drug can reduce perioperative myocardial infarction and/or mortality. Nonetheless, clonidine, aspirin, statins, and calcium antagonists probably have beneficial effects. Beta-blockers are strongly recommended by international guidelines, but benefits and hazards should be carefully considered. In cardiac surgery the rate of perioperative myocardial infarction and/or mortality is higher than in non-cardiac surgery, but there are still no international guidelines to help physicians to select the best possible drug for the individual patient. Surprisingly, meta-analysis suggests that volatile agents reduce myocardial infarction (number needed to treat [NNT] = 37) and mortality (NNT = 83) in cardiac surgery when compared to total intravenous anesthesia, but no data regarding the use of volatile agents in non-cardiac surgery exist. Levosimendan reduces myocardial infarction (NNT = 21) and mortality (NNT = 12) in cardiac surgery when compared to placebo or other inotropic agents, but no data regarding its use in non-cardiac surgery exist. Epidural analgesia has promising beneficial effects in both cardiac and non-cardiac surgery.

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Author information

Authors and Affiliations

  1. Department of Anaesthesia and Intensive Care, “Vita-Salute” University, IRCCS H. San Raffaele, Milan, Italy

    Giovanni Landoni & Elena Bignami

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  1. Giovanni Landoni
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  2. Elena Bignami
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Editors and Affiliations

  1. Department of Vascular Surgery, “Vita-Salute” University, IRCCS H., San Raffaele, Milan, Italy

    Roberto Chiesa , Germano Melissano  & Alberto Zangrillo ,  & 

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Landoni, G., Bignami, E. (2011). Perioperative Pharmacological Cardiac Protection. In: Chiesa, R., Melissano, G., Zangrillo, A. (eds) Thoraco-Abdominal Aorta. Springer, Milano. https://doi.org/10.1007/978-88-470-1857-0_17

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  • DOI: https://doi.org/10.1007/978-88-470-1857-0_17

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-1856-3

  • Online ISBN: 978-88-470-1857-0

  • eBook Packages: MedicineMedicine (R0)

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