Abstract
The aim of this prospective study was to evaluate the post-operative haemodynamic variables and medication requirements in patients with perioperative myocardial infarction (PM1), following elective coronary artery bypass graft (CABG) surgery, as documented by technetium pyrophosphate scintigraphy using single-photon emission computed tomography (TcPPi-SPECT). A high-dose fentanyl anaesthetic technique was applied. Twelve of 58 patients (21%) developed PMI with an infarcted myocardial mass of 35.7 ± 3.9 g. Over the 48 hr postoperative period, patients with positive TcPPi-SPECT (n = 12) did not differ from those with negative TcPPi-SPECT (n = 46) in mean heart rate (below 100 bpm), systolic blood pressure (100–120 mmHg) or central venous pressure (8–16 mmHg). However, patients with positive TcPPi-SPECT had higher pulmonary artery diastolic pressures at 5–8 hr after surgery. No differences were found in the incidence and dosage requirements for postoperative sedative or vasoactive drugs (morphine, diazepam, propranolol, lidocaine, nitroglycerin and nitroprusside) between the two groups. There was no difference in the incidence of dopamine requirement between the groups (positive-scan: 16.7%, negative-scan: 13.0%). However, the dopamine dosage for inotropic support was higher in the positive TcPPi-SPECT group over 24 hr (318.5 ± 125.2 mg vs 71.2 ±24.7 mg, P < 0.05) and 48 hr (869.1 ± 19.0 mg vs 142.3 ± 49.4 mg, P < 0.001) periods after surgery. We postulate that careful control of postoperative haemodynamic variables did not prevent but may limit the extent of PMI in elective CABG patients.
Résumé
Les buts de cette étude prospective étaient d’évaluer les variables hémodynamiques postopératoires et les médicaments requis chez des patients ayant un infarctus du myocarde pério-pératoire (PMI), après pontage aortocoronarien électif et documenté par une scintigraphie au technitium pyrophosphate utilisant la tomographie computée par émission d’un photon unique (TcPPi-SPECT). Une technique anesthésique à haute dose de fentanyl fut utilisée. Douze des 58 patients (21%) ont développé un PMI avec une masse myocardique infarcisée de 35,7 ± 3,9 g. Au cours d’une période de 48 heures postopératoires, des patients avec un TcPPi-SPECT positif (n = 12) n ’ont pas démontré de différence avec ceux qui avaient un TcPPi-SPECT négatif (n = 46) quant à la fréquence (inférieure à 100 bpm), pression artérielle systolique (100–120 mmHg) ou la pression veineuse centrale (8–16 mmHg). Cependant, les patients ayant présenté un TcPPi-SPECT positif avaient des pressions diastoliques de l’artère pulmonaire élevées à 5–8 heures après la chirurgie. Aucune différence entre les deux groupes ne fut trouvée dans l’incidence et la nécessité de sédation postopératoire ou dans les drogues vasoactives (morphine, diazépam, propranolol, lidocaïne, nitroglycérine et nitroprussiate). Il n’y avait aucune différence dans l’incidence de la nécessité d’administrer de la dopamine entre les groupes (scan positif: 16,7%, scan négatif: 13,0%). Cependant, le support inotrope avec la dopamine fut significativement plus élevé dans le groupe TcPPi-SPECT positif au cours des 24 heures (318,5 ± 125,2 mg vs 71,2 ± 24,7 mg, P < 0.05) et 48 heures (869,1 ± 19,0 mg vs 142,3 ± 49,4 mg, P < 0.001) après la chirurgie. On postule qu’un contrôle méticuleux des variables hémodynamiques en période postopératoire n ’a pas empêché mais aurait pu limiter l’étendue du PMI chez les patients ayant subi un pontage aortocoronarien électif.
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References
Slogoff S. Keats AS. Does perioperative myocardial is-chemia lead to postoperative myocardial infarction? Anesthesiology 1985; 62: 107–14.
Slogoff S, Keats AS. Further observations on perioperative myocardial ischemia. Anesthesiology 1986; 65: 539–42.
Cheng DCH, Chung F, Burns RJ, Houston PL, Feindel CM. Postoperative myocardial infarction documented by technetium pyrophosphate scan using single-photon emission computed tomography: significance of intraoperative myocardial ischemia and hemodynamic control. Anesthesiology 1989; 71: 818–26.
Smith RC, Leung JM, Mangano DT, S.P.I. Research Group. Postoperative myocardial ischemia in patients undergoing coronary artery bypass graft surgery. Anesthesiology 1991; 74: 464–73.
Leung J, O’Kelly B, Browner W, Tubau J, Hollenberg M, Mangano DT, S.P.I. Research Group. Prognostic importance of postbypass regional wall-motion abnormalities in patients undergoing coronary artery bypass graft surgery. Anesthesiology 1989; 71: 16–25.
Burns RJ, Gladstone PJ, Tremblay PC et al. Myocardial infarction determined by Technetium-99m Pyrophosphate Single-Photon Tomography complicating elective coronary artery bypass grafting for angina pectoris. Am J Cardiol 1989; 63: 1429–34.
Kennedy JW, Kaiser GC, Fisher LD. Multivariate discriminant analysis of the clinical and angiographic predictors of operative mortality from the collaborative study in coronary artery surgery (CASS). J Thorac Cardiovasc Surg 1980; 80: 876–87.
Kennedy JW, Kaiser GC, Fisher LD et al. Clinical and angiographic predictors of operative mortality from the collaborative study in coronary artery surgery (CASS). Circulation 1981; 63: 793–802.
Li W, Hanelin LG, Riggins RCK, Agnew RC, Annest LS, Anderson RP. Perioperative ischemic injury after coronary bypass graft surgery. Am J Surg 1985; 150: 122–6.
Pelletier C, Cassette R, Donligny L, Mercier C, Page A, Verdant A. Determinants of mortality following coronary bypass surgery. Can J Surg 1980; 23: 199–204.
Chaitman BR, Alderman EL, Sheffield LT et al. Use of survival analysis to determine the clinical significance of new Q waves after coronary bypass surgery. Circulation 1983; 67: 302–9.
Namay DL, Hammermeister KE, Zia MS, DeRouen TA, Dodge HT, Namay K. Effect of perioperative myocardial infarction on late survival in patients undergoing coronary artery bypass surgery. Circulation 1982; 65: 1066–71.
Schaff HV, Gersh BJ, Fisher LD et al. Detrimental effect of perioperative myocardial infarction on late survival after coronary artery bypass. Report from the coronary artery surgery study (CASS). J Thorac Cardiovasc Surg 1984; 88: 972–81.
Guiteras-Val PC, Pelletier LC, Hernandez MG et al. Diagnostic criteria and prognosis of perioperative myocardial infarction following coronary bypass. J Thorac Cardiovasc Surg 1983; 86: 878–86.
Herlitz J, Hjalmarson A, Lomsky M, Wiklund I. The relationship between infarct size and mortality and morbidity during short-term and long-term follow-up after acute myocardial infarction. Am Heart J 1988; 116: 1378–82.
Geltman EM, Ehsani AA, Campbell MK, Schechtman K, Roberts R, Sobel BE. The influence of location and extent of myocardial infarction on long-term ventricular dysrhythmia and mortality. Circulation 1979; 60: 805–14.
Roberts AJ, Codes JR, Jacobstein JG et al. Perioperative myocardial infarction associated with coronary artery bypass graft surgery; improved sensitivity in the diagnosis within 6 hours after operation with 99m Tc-gluco-heptonate myocardial imaging and myocardial-specific isoenzymes. Ann Thorac Surg 1979; 27: 42–8
Mahmarian JJ, Pratt CM, Borges-Neto S, Cashion WR, Roberts R, Verani MS. Quantification of infarct size by 201T1 single-photon emission computer tomography during acute myocardial infarction in humans. Comparison with enzymatic estimates. Circulation 1988; 78: 831–9.
Rao TLK, Jacobs KH, El-Etr AA. Reinfarction following anesthesia in patients with myocardial infarction. Anesthesiology 1983; 59: 499–505.
Tuman KJ, McCarthy RJ, Spiess BD et al. Effect of pulmonary artery catheterization on outcome in patients undergoing coronary artery surgery. Anesthesiology 1989; 70: 199–206.
Hansen RM, Viquerat CE, Matthay MA et al. Poor correlation between pulmonary arterial wedge pressure and left ventricular end-diastolic volume after coronary artery bypass graft surgery. Anesthesiology 1986; 64: 764–70.
Slogoff S, Keats AS. Randomized trial of primary anesthetic agents on outcome of coronary artery bypass operations. Anesthesiology 1989; 70: 179–88.
Tuman KJ. McCarthy RJ, Spiess BD, DaValle M, Dabir R, Ivankovich AD. Does choice of anesthetic agent significantly affect outcome after coronary artery surgery? Anesthesiology 1989; 70: 189–98.
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Cheng, D.C.H., Burns, R.J., Chung, F. et al. Postoperative haemodynamic and pharmacological responses in patients with positive technetium pyrophosphate single-photon emission computed tomography following CABG. Can J Anaesth 39, 47–53 (1992). https://doi.org/10.1007/BF03008672
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DOI: https://doi.org/10.1007/BF03008672