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Intensive Care Med. 2018 Jun;44(6):811-822. doi: 10.1007/s00134-018-5224-7. Epub 2018 Jun 4.

Perioperative myocardial injury and the contribution of hypotension.

Author information

1
Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave-P77, Cleveland, OH, 44195, USA. DS@OR.org.
2
Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave-P77, Cleveland, OH, 44195, USA.
3
Departments of General Anesthesiology and Center for Critical Care, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA.

Abstract

Mortality in the month following surgery is about 1000 times greater than anesthesia-related intraoperative mortality, and myocardial injury appears to be the leading cause. There is currently no known safe prophylaxis for postoperative myocardial injury, but there are strong associations among hypotension and myocardial injury, renal injury, and death. During surgery, the harm threshold is a mean arterial pressure of about 65 mmHg. In critical care units, the threshold appears to be considerably greater, perhaps 90 mmHg. The threshold triggering injury on surgical wards remains unclear but may be in between. Much of the association between hypotension and serious complications surely results from residual confounding, but sparse randomized data suggest that at least some harm can be prevented by intervening to limit hypotension. Reducing hypotension may therefore improve perioperative outcomes.

KEYWORDS:

Anesthesia; Blood pressure; Critical care; Hypotension; Mortality; Myocardial injury; Renal injury

PMID:
29868971
DOI:
10.1007/s00134-018-5224-7
[Indexed for MEDLINE]

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