0
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Prevención de complicaciones perioperatorias en pacientes con enfermedades cardiovasculares Translated title: Preventing perioperative complications in patients with cardiovascular diseases

      review-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Introducción: el acto de prevenir constituye una piedra angular en el campo de la medicina; la Anestesiología no queda excluida de las ventajas que esto representa tanto para el paciente como para el anestesiólogo. Las complicaciones cardiovasculares perioperatorias son causa de alta morbimortalidad en el paciente quirúrgico, por lo que se hace necesaria su prevención. Objetivo: exponer una serie de medidas de prevención de complicaciones cardiovasculares en pacientes cardiópatas para cirugía no cardiaca. Métodos: se realizó una revisión bibliográfica en Pubmed mediante el gestor de referencias Enanote. De ellos fueron seleccionados 24 artículos de interés para el desarrollo del tema. Se desarrollaron un conjunto de intervenciones preventivas perioperatorias, con el fin de evitar o minimizar el riesgo de complicaciones cardiovasculares en pacientes portadores de afecciones cardiacas para cirugía extracardiaca. Conclusiones: las complicaciones cardiovasculares pueden ser prevenidas mediante el conocimiento de los aspectos clínicos de las enfermedades cardiacas, correcta evaluación preoperatoria, adecuada vigilancia del paciente, elaboración y conducción de un plan anestésico integral e individualizado; así como de óptimos cuidados posoperatorios.

          Translated abstract

          Introduction: prevention is crucial in all areas of health care, not least anesthesiology, where its benefits for both patients and specialists are notable. Perioperative cardiovascular complications cause high morbidity and mortality among surgical patients. Therefore, it is very important to prevent such complications. Objective: present a number of measures aimed at preventing cardiovascular complications in cardiac patients undergoing non-cardiac surgery. Methods: a literature review was conducted on Pub Med using the EndNote reference manager. 24 papers related to the topic were selected. A number of preventive perioperative interventions were developed aimed at either preventing or minimizing the risk of cardiovascular complications in patients with heart conditions undergoing non-cardiac surgery. Conclusions: cardiovascular complications may be prevented with knowledge of the clinical aspects of heart conditions, as well as an appropriate preoperative evaluation, adequate patient surveillance, development and application of a comprehensive, individualized anesthetic plan, and optimal postoperative care.

          Related collections

          Most cited references24

          • Record: found
          • Abstract: found
          • Article: not found

          Coronary-artery revascularization before elective major vascular surgery.

          The benefit of coronary-artery revascularization before elective major vascular surgery is unclear. We randomly assigned patients at increased risk for perioperative cardiac complications and clinically significant coronary artery disease to undergo either revascularization or no revascularization before elective major vascular surgery. The primary end point was long-term mortality. Of 5859 patients scheduled for vascular operations at 18 Veterans Affairs medical centers, 510 (9 percent) were eligible for the study and were randomly assigned to either coronary-artery revascularization before surgery or no revascularization before surgery. The indications for a vascular operation were an expanding abdominal aortic aneurysm (33 percent) or arterial occlusive disease of the legs (67 percent). Among the patients assigned to preoperative coronary-artery revascularization, percutaneous coronary intervention was performed in 59 percent, and bypass surgery was performed in 41 percent. The median time from randomization to vascular surgery was 54 days in the revascularization group and 18 days in the group not undergoing revascularization (P<0.001). At 2.7 years after randomization, mortality in the revascularization group was 22 percent and in the no-revascularization group 23 percent (relative risk, 0.98; 95 percent confidence interval, 0.70 to 1.37; P=0.92). Within 30 days after the vascular operation, a postoperative myocardial infarction, defined by elevated troponin levels, occurred in 12 percent of the revascularization group and 14 percent of the no-revascularization group (P=0.37). Coronary-artery revascularization before elective vascular surgery does not significantly alter the long-term outcome. On the basis of these data, a strategy of coronary-artery revascularization before elective vascular surgery among patients with stable cardiac symptoms cannot be recommended. Copyright 2004 Massachusetts Medical Society.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Evidence of pre-procedural statin therapy a meta-analysis of randomized trials.

            The purpose of this study was to summarize the evidence of pre-procedural statin therapy to reduce periprocedure cardiovascular events. Invasive procedures can result in adverse cardiovascular events, such as myocardial infarction (MI) and death. We hypothesized that statins might improve clinical outcomes when used before invasive procedures. We searched the MEDLINE, Cochrane, and clinicaltrials.gov databases from inception to February 2010 for randomized, controlled trials that examined statin therapy before invasive procedures. Invasive procedures were defined as percutaneous coronary intervention, coronary artery bypass grafting (CABG), and noncardiac surgery. We required that studies initiated statins before the procedure and reported clinical outcomes. A DerSimonian-Laird model was used to construct random-effects summary risk ratios. Eight percent of the screened trials (21 of 270) met our selection criteria, which included 4,805 patients. The use of pre-procedural statins significantly reduced post-procedural MI (risk ratio [RR]: 0.57, 95% confidence interval [CI]: 0.46 to 0.70, p < 0.0001). This benefit was seen after both percutaneous coronary intervention (p < 0.0001) and noncardiac surgical procedures (p = 0.004), but not CABG (p = 0.40). All-cause mortality was nonsignificantly reduced by statin therapy (RR: 0.66, 95% CI: 0.37 to 1.17, p = 0.15). Pre-procedural statins also reduced post-CABG atrial fibrillation (RR: 0.54, 95% CI: 0.43 to 0.68, p < 0.0001). Statins administered before invasive procedures significantly reduce the hazard of post-procedural MI. Additionally, statins reduce the risk of atrial fibrillation after CABG. The routine use of statins before invasive procedures should be considered. Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Perioperative management of warfarin and antiplatelet therapy.

              Perioperative management of patients on warfarin or antiplatelet therapy involves assessing and balancing individual risks for thromboembolism and bleeding. Discontinuing anticoagulant and antiplatelet therapy is usually necessary for major surgery but increases the risk of thrombotic events. Bridge therapy, the temporary perioperative substitution of low-molecular-weight heparin or unfractionated heparin in place of warfarin, is an effective means of reducing the risk of thromboembolism but may increase the risk of bleeding. The timing of warfarin withdrawal and timing of the preoperative and postoperative components of bridge therapy are critical to balancing these risks. Perioperative management of antiplatelet therapy requires special care in patients with coronary stents; the timing of surgery relative to stent placement dictates management in these patients.
                Bookmark

                Author and article information

                Journal
                scar
                Revista Cubana de Anestesiología y Reanimación
                Rev. Cuban de Anestesiol y Reanim
                Editorial Ciencias Médicas (Ciudad de la Habana, , Cuba )
                1726-6718
                December 2012
                : 11
                : 3
                : 211-219
                Affiliations
                [01] Camagüey orgnameHospital Provincial Universitario Clínico Quirúrgico Manuel Ascunce Domenech Cuba
                Article
                S1726-67182012000300008 S1726-6718(12)01100308
                b933ec0b-feec-4d77-8ee1-05b52bd37602

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 28 February 2012
                : 07 December 2011
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 24, Pages: 9
                Product

                SciELO Cuba

                Categories
                ARTÍCULOS DE REVISIÓN

                complicaciones cardiovasculares perioperatorias,prevention,risk factors,heart diseases,perioperative cardiovascular complications,prevención,factores de riesgo,enfermedades cardiacas

                Comments

                Comment on this article