Reducing perioperative myocardial infarction with anesthetic drugs and techniques.

BACKGROUND

Until now no randomized trial can be considered powered enough to show a reduction on both perioperative myocardial infarction and mortality.

METHODS

We performed an extensive research of the literature to identify drugs or technique that could have an effect on perioperative myocardial infarction in cardiac and non-cardiac surgery.

RESULTS

Volatile agents reduce myocardial infarction (NNT=37) and mortality (NNT=83) in cardiac surgery when compared to total intravenous anesthesia. No data regarding the use of volatile agents in non-cardiac surgery exists. Levosimendan reduces myocardial infarction (NNT=21) and mortality (NNT=12) in cardiac surgery when compared to placebo or other inotropic agents. No data regarding its use in non-cardiac surgery exists. Epidural analgesia has promising beneficial effects in both cardiac and on-cardiac surgery. In non cardiac surgery statins, and calcium antagonists have minor beneficial effects while alpha(2) agonists could reduce perioperative mycoardial infarction and are included in the American College of Cardiology / American Heart Association Guidelines. Beta blockers are also included in the international guidelines but benefits and hazards should be careful considered.

CONCLUSIONS

Volatile agents and levosimendan consistently reduce perioperative myocardial infarction and mortality in cardiac surgery but they have not been properly studied in non-cardiac surgery. Minor (epidural analgesia, statins, calcium antagonists and alpha(2) agonists) or doubtful (beta-blockers) results were found in non-cardiac surgery.