Thromboembolic Events in the Perioperative Period Lier, F. van 2011-01-26 Doctoral Thesis

The first chapter provides an overview of cardiovascular risk identification and modification in the perioperative period. In this chapter the identification of patients at risk using various risk models and biomarkers is described. Noninvasive and invasive preoperative (stress) testing as well as preoperative coronary revascularization is discussed. Finally short- and long-term risk reduction strategies such as beta-blocker therapy, statins and aspirins are evaluated. Chapter 2 summarizes the findings on perioperative stroke in noncardiac surgery. This chapter describes the pathophysiology of perioperative stroke and focuses on important issues regarding the initiation of beta-blocker therapy preoperative. Chapter 3 and 4 evaluate the risk for perioperative stroke in patients on beta-blocker therapy. Risk factors for perioperative stroke are discussed. Perioperative stroke is evaluated in patients on chronic beta-blocker use as well as in patients where beta-blockers are initiated prior to surgery. Intraoperative cardiac arrests are discussed in chapter 5. In a case-control study of surgical patients at the Erasmus Medical Center, the relationship between preoperative cardiovascular risk factors and intraoperative cardiac events is analyzed. In chapter 6 a risk model for postoperative pulmonary embolism after noncardiac surgery is developed. This chapter highlights the importance of on time thromboprophylaxis in relation to adverse postoperative venous thromboembolic processes. Chapter 7 describes the value of statins in the (postoperative) intensive care period. Proper use of statins in the postoperative period after both cardiac and noncardiac surgery is discussed. The second part of the chapter focuses on potential indications for statin therapy in the near future. The indication of statins has expanded to other patient categories often admitted to an intensive care unit. Therefore statin therapy may be the next logical step in the search for adjuvant therapy in common intensive cares diseases. The final chapter, chapter 8, discusses the value of epidural analgesia in addition to general anesthesia in COPD patients undergoing major abdominal surgery. Epidural analgesia is associated with improved outcome in surgical patients. However, since epidural analgesia might worsen postoperative respiratory function, it is unclear whether COPD patients benefit from epidural analgesia. This study aimed to examine the effects of epidural analgesia in addition to general anesthesia in COPD patients scheduled for major abdominal surgery.
http://repub.eur.nl/res/pub/22288/110126_Lier%2C%20Felix%20van.pdf