Perioperative myocardial injury and the contribution of hypotension

• Published in: Intensive care medicine Vol. 44; no. 6; pp. 811 - 822
• Main Authors: Sessler, Daniel I., Khanna, Ashish K.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2018; Springer; Springer Nature B.V
• Subjects: Anesthesia; Anesthesiology; Arterial Pressure; Blood pressure; Cardiovascular disease; Catheters; Complications; Critical Care Medicine; Cyclin-dependent kinases; Emergency Medicine; Heart Injuries; Humans; Hypotension; Hypotension - complications; Injuries; Intensive; Intensive care; Medicine; Medicine & Public Health; Mortality; Myocardium - pathology; Pain Medicine; Pediatrics; Pneumology/Respiratory System; Postoperative Complications - etiology; Postoperative Period; Prophylaxis; Review; Surgery; Surgical outcomes; Surgical Procedures, Operative; Renal injury; Mortality; Critical care; Anesthesia; Blood pressure; Hypotension; Myocardial injury
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-018-5224-7

Mortality in the month following surgery is about 1000 times greater than anesthesia-related intraoperative mortality, and myocardial injury appears to be the leading cause. There is currently no known safe prophylaxis for postoperative myocardial injury, but there are strong associations among hypotension and myocardial injury, renal injury, and death. During surgery, the harm threshold is a mean arterial pressure of about 65 mmHg. In critical care units, the threshold appears to be considerably greater, perhaps 90 mmHg. The threshold triggering injury on surgical wards remains unclear but may be in between. Much of the association between hypotension and serious complications surely results from residual confounding, but sparse randomized data suggest that at least some harm can be prevented by intervening to limit hypotension. Reducing hypotension may therefore improve perioperative outcomes.