Heart rate and outcome in patients with cardiovascular disease undergoing major noncardiac surgery

被引:9
作者
Biccard, B. M. [1 ,2 ,3 ]
机构
[1] Nelson R Mandcla Sch Med, Dept Anaesthet, ZA-4013 Congella, South Africa
[2] Inkosi Albert Luthuli Cent Hosp, Dept Anaesthet, Mayville, South Africa
[3] Univ Oxford, John Radcliffe Hosp, Nuffield Dept Anaesthet, Oxford OX3 9DU, England
关键词
heart; heart rate; risk assessment; risk factors; complications; death; surgery; vascular;
D O I
10.1177/0310057X0803600403
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
There is all increasing awareness that all elevated resting heart rate is associated with increased all-cause mortality, in the general population and that this may be all independent coronary risk factor. This review was undertaken to determine whether heart rate is predictive of increased mortality and major morbidity in noncardiac surgical patients and whether heart rate manipulation improves perioperative outcome. A search of Medline from 1966 until October 2007 was conducted using the terms "heart rate", "surgery", "cardiac", "morbidity", "mortality" and perioperative". The main findings were that an elevated perioperative heart late, all absolute increase in heart rate and heart rate lability are independent predictors of both short- and long-term adverse outcomes in patients at cardiovascular risk undergoing major noncardiac surgery. Although prospective nonrandomised and retrospective data suggest heart rate control improves perioperative outcome, there is conflicting evidence from randomised trials that perioperative heart rate control improves outcome. This may be because drug-associated bradycardia influences mortality in the perioperative period. Further studies reporting the absolute heart rate, the absolute change of heart rate and the time-period of the observations are needed to identify early warning systems, which may allow earlier triage and improved outcome. Enthusiasm for this approach must be tempered by the appreciation that a J-shaped relationship probably exists between heart rate and morbidity, particularly following bradycardic therapy. Therefore, any bradycardic manipulation of heart rate in the perioperative period must be accompanied by simultaneous attention to other physiological variables associated with increased morbidity and mortality.
引用
收藏
页码:489 / 501
页数:13
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