Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
5580420 | Anesthésie & Réanimation | 2017 | 10 Pages |
Abstract
Patient with coronary artery disease in noncardiac surgery is a population at risk for perioperative myocardial ischaemia. Knowledge of the pathophysiology of myocardial ischemia and infarction during the perioperative period makes it possible to determine the various parameters to be monitored during a general anaesthesia. The main objective is to avoid myocardial ischaemia, which is the bed of myocardial infarction. Mean arterial pressure monitoring (MAP) is essential with a MAP greater than 65Â mmHg and/or a MAP greater than 80Â % of the reference value. Ideally, its continuous measurement is desirable but it depends on the anaesthetic risk, especially since it implies the realization of an invasive gesture motivating the development of new noninvasive monitoring monitors. The same is true for the monitoring of cardiac output, the target of which must be personalized and adapted to each patient by titrating the filling by measuring the volume of systolic ejection associated with a regular re-evaluation. It will be in this review exposed diverse types of monitors more or less invasive. In addition, the establishment of transfusion thresholds is a dynamic and complex process, a target haemoglobin between 8Â and 10Â g/dL is to be adapted according to the haemorrhagic risk, the severity of the coronary artery disease, the evolution of the bleeding and the other haemodynamic parameters. Heart rate, temperature and SpO2Â are also an integral part of haemodynamic optimization in the coronary patient. The strategy of standardized haemodynamic optimization in the coronary patient is part of a multimodal process, which involves the development of new monitors less and less invasive.
Keywords
Related Topics
Health Sciences
Medicine and Dentistry
Anesthesiology and Pain Medicine
Authors
Alex Hong, Arthur Le Gall, Etienne Gayat,