Perioperative myocardial perfusion: an anesthesiologists' concern?

ABSTRACT

PURPOSE OF REVIEW Cardiac complication following noncardiac surgery is the leading cause of death in the perioperative period. Disturbances in myocardial perfusion are at the basis of these complications. The purpose of this review was to summarize the most recent findings on factors affecting myocardial perfusion in the perioperative period and possibilities for monitoring disturbances in myocardial perfusion. RECENT FINDINGS: Clinical studies in cardiovascular healthy patients show mild influences of general anesthetics on myocardial perfusion. No clear benefit could be detected for the use of volatile anesthetics over intravenous anesthetics in patients at risk for disturbances in myocardial perfusion. Etomidate should be used with caution in American Society of Anesthesiologists class 3 and 4 patients. Recent studies focused on effects of decreased perfusion pressure, lowering myocardial oxygen demand and impaired oxygen delivery on myocardial perfusion. Promising results are reported on monitoring perioperative myocardial perfusion using troponin and NT-pro-B-type natriuretic peptides. SUMMARY: General anesthesia only mildly influences myocardial perfusion in cardiovascular healthy patients. Further research is necessary to determine whether this is also the case for cardiovascular-compromised patients. Monitoring troponin levels in the perioperative setting may be useful for predicting cardiovascular events in at-risk patients.