Myocardial Protection Of Inhalational Anesthetics In Elderly Patients With Coronary Artery Disease Undergoing Non-cardiac Surgery

Background:Cardiac adverse events are important causes of perioperative morbidity and mortality in elderly patients with coronary heart disease (CHD) undergoing noncardiac surgery. With the growing elderly population, of the number of patients with underlying cardiovascular disease will increase, and with the availability of advanced surgical anesthetic techniques, more and more elderly patients with CHD will undergo noncardiac surgery. However, the myocardial protection of inhalational anesthetics in these patients has not been addressed. And there is no data focusing on perioperative myocardial protective method in elderly patients with CHD. In the growing elderly population with an increased CHD incidence, more attention should be paid on these patients to investigate the availability of protective techniques.Objective:The purpose of this study was to identify the epidemiologic characteristics of perioperative cardiac adverse events after noncardiac surgery for elderly patients with CHD, try to evaluate the myocardial protective effects of inhalational anesthetics in these patiets. Try to develope strategy of anesthetic management during perioperative time.Methods:It was a multicenter prospective randomized evaluator-blinded controlled clinical study, including382elderly patients with CHD undergoing elective major noncardiac surgery in four medical centers in China. The patients were randomized into inhalational group and intravenous group. The primary endpoint was perioperative cardiac adverse events, and the secondary endpoint was postoperative myocardial ischemia. The risk factors of perioperative cardiac adverse events and postoperative myocardial ischemia were analyzed with multivariable logistic regression in SAS, together with myocardial protective effect of inhalational anesthetics. The influential effect on intraoperative hemodynamic by different anesthetics was investigated by using Gener-Mized estimating equation (GEE).Results:Perioperative cardiac adverse events occurred in9.33%elderly patients with CHD undergoing noncardiac surgery. After adjusting for NYHA cardiac function classification, there was no statistic difference on perioperative cardiac aderse events between inhalational group and intravenous group. The incidence of postoperative myocardial ischemia for inhalational group was significantly lower on postoperative day one and postoperative day two. After adjusting for sex and history of hypertention, the inhalational anesthetic was still the independent protective factor of intraoperative hypertention for elderly patients with CHD undergoing noncardiac surgery.Conclusions:Elderly patients with CHD were proved to be a high-risk population of perioperative cardiac adverse events when undergoing noncardiac surgery. Administration of inhalational anesthetics could reduce the occurrence of intraoperative hypertention and postoperative myocardial ischemia. However, it did not change the cardiac outcomes in terms of perioperative cardiac adverse events and mortality. Inhalational anesthetic was effective in myocardial protection for elderly patients with CHD, and could be used as anesthetic agent for these patients undergoing noncardiac surgery.