Myocardial injury in patients with hypertonic disease at osteosynthesis of the hip and spinal anesthesia

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BACKGROUND: Perioperative myocardial injury (MI) and MI after noncardiac surgery (MINS) makes a significant contribution to the structure of complications and mortality in non-cardiac surgery, including those in traumatology. Spinal anesthesia (SA) is usually used for hip surgery. It may be accompanied by arterial hypotension, which, under certain conditions, becomes a leading factor in MI development. Features of both hypotension and MI in patients with concomitant cardiovascular pathology operated on for hip injury remain insufficiently studied.

AIM: To determine the frequency of intraoperative arterial hypotension and MI after intraosseous osteosynthesis of the hip under spinal anesthesia in patients with concomitant cardiovascular pathology.

MATERIAL AND METHODS: In 275 patients with concomitant cardiovascular pathology, intraosseous synthesis of the hip was performed with SA. The functional class of the patients was assessed according to the American Society of Anesthesiologists scale and the risk of cardiac complications according to the Revised Cardiac Risk Index scale. Blood pressure, heart rate, electrocardiogram, and ST segment were monitored. Before surgery and 1–3 days thereafter, the troponin T level was measured. The frequency of MI and surgical outcomes were assessed.

RESULTS: In the studied sample of patients with hypertonic disease, arterial hypotension associated with SA was observed in 34.2% of cases. Its frequency increased from 15.7% in patients without other comorbidities to 42.9% in patients with a combination of hypertonic disease, CAD, and CHF. A significant relationship was noted between arterial hypotension and MI. A highly sensitive troponin test revealed a significant incidence of myocardial damage (18.2%), and the associated 3-day mortality was 4%.

CONCLUSION: SA-induced arterial hypotension is associated with MI risk and appears to be the most dangerous in patients with a combination of hypertonic disease, CAD, and CHF. Monitoring of troponin T levels in patients with risk factors of MI is one of the ways to reduce postoperative mortality and improve surgery outcomes.

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About the authors

Alexander S. Komarov

Yaroslavl State Medical University

Author for correspondence.
ORCID iD: 0000-0002-6650-9630

Assistant of the Department

Russian Federation, sq. 4, 41, Malaya Proletarskaya str., Yaroslavl, Yaroslavl region, 150001

Dmitry A. Sokolov

Yaroslavl State Medical University

ORCID iD: 0000-0002-8186-8236

MD, Cand. Sci. (Med.), associate professor

Russian Federation, Yaroslavl

Andrey N. Ganert

Yaroslavl State Medical University

ORCID iD: 0000-0001-5816-4620

MD, Cand. Sci. (Med.), associate professor

Russian Federation, Yaroslavl

Pavel A. Lyuboshevskii

Yaroslavl State Medical University

ORCID iD: 0000-0002-7460-9519

MD, Dr. Sci. (Med.), associate professor

Russian Federation, Yaroslavl


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Supplementary files

Supplementary Files
1. Fig. ROC-curves reflecting the sensitivity and specificity of blood pressure levels in relation to the risk of myocardial injury. 1-1. Minimal systolic blood pressure. 1-2. Minimal diastolic blood pressure. 1-3. Minimal mean blood pressure

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