16 de abril de 2013

Artigo recomendado: Two ‘Lows’ Better Than Three For Anesthesia Outcomes

Results from cardiac surgery study differ from earlier analysis in other patients

by Michael Vlessides
Clinical Anesthesiology, ISSUE: FEBRUARY 2013 | VOLUME: 39:2

Washington - Patients who experience a “double low” of blood pressure and brain function during cardiac surgery do not appear to be at higher risk for perioperative death, a recent study suggests.

The findings diverge from previous research showing that a “triple low” of mean arterial pressure (MAP) and low bispectral index (BIS; Covidien) values during low minimum alveolar concentration (MAC) is a strong predictor of mortality in non-cardiac patients (see Anesthesiology News, November 2009, page 1).

“Anesthesiologists are increasingly involved in controlling intraoperative variables that impact postoperative outcomes, including hypothermia, transfusion and glucose control,” said Ankit Maheshwari, MD, an anesthesia resident at Cleveland Clinic, in Ohio, who helped conduct the latest study. “In addition, very low blood pressure—or extremes of blood pressure—and anesthetic depth have been shown to predict worse outcomes.”

Using data from the institution’s electronic anesthesia record and cardiothoracic anesthesia registry, Dr. Maheshwari and his colleagues grouped 3,445 patients into categories based on time-weighted BIS and MAP scores. For technical reasons, MAC fraction was not available in this patient population, Dr. Maheshwari said.

Patients were included in the reference group if their time-weighted MAP and BIS scores were within 1 standard deviation of the mean.

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