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LETTER TO THE EDITOR

Anesthesia Research Needs Definitions

Department of Anesthesia and Critical Care, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil, lfmbns{at}superig.com.br

To the Editor:

Outcome research is essential to improving care. Initiatives pursuing this goal are to be applauded. Approximately 40% of surgical patients in the United States have risk factors or overt coronary artery disease (1). Improvements in preoperative care, anesthesia techniques, and surgical procedures continuously modify morbidity regardless of the population analyzed. Seki et al. (2) exemplify the difficulties of studying and comparing the uncountable variables anesthesiologists encounter daily. Video laparoscopic cholecystectomies in young diabetic women and pneumectomies in octogenarians have the same enrollment criteria in this series. In addition, ST-T changes, severe dysrhythmias, and conduction defects are subjective descriptors. Frequency-dependent bundle-branch blocks do not mean ischemia and alter repolarization considerably. Hypontension is not only a complication but also a protective anesthetic technique. Follow-up is another source of variability. Troponin T is a state-of-the-art cardiac injury marker (3,4). As with electrocardiograms, it indicates acute myocardial infarction in appropriate scenarios but awaits consensus on when and how often it should be obtained in asymptomatic postoperative patients (5). Cardiologists have improved definitions and outcome research methodology incessantly despite much simpler events and endpoints (6,7). Using established terminologies or adapting them to anesthesiology research worldwide is essential to compare results regardless of the population studied.

Footnotes

Dr. Seki does not wish to respond.

References

1. Mangano DT, Goldman L. Preoperative assessment of patients with known or suspected coronary disease. N Engl J Med 1995;333:1750–6.[Free Full Text]
2. Seki M, Kashimoto S, Nagata O, et al. Are the incidences of cardiac events during noncardiac surgery in Japan the same as in the United States and Europe? Anesth Analg 2005;100:1236–40.[Abstract/Free Full Text]
3. French JK, White HD. Clinical implications of the new definitions of myocardial infarction. Heart 2004;90:99–106.[Free Full Text]
4. Jaffe AS. A small step for man, a leap forward for postoperative management. J Am Coll Cardiol 2003;42:1547–54.[Abstract/Free Full Text]
5. Manach YL, Perel A, Coriat P, et al. Early and delayed myocardial infarction after abdominal aortic surgery. Anesthesiology 2005;102:885–91.[Web of Science][Medline]
6. Luepker RV, Apple FS, Christenson RH, et al. Case definitions for acute coronary heart disease in epidemiology and clinical research studies: a statement from the AHA Council on Epidemiology and Prevention; AHA Statistics Committee; World Heart Federation Council on Epidemiology and Prevention; the European Society of Cardiology Working Group on Epidemiology and Prevention; Centers for Disease Control and Prevention; and the National Heart, Lung, and Blood Institute. Circulation 2003;108:2543–9.[Free Full Text]
7. Krumholz HM, Peterson ED, Ayanian JZ, et al. Report of the National Heart, Lung, and Blood Institute Working Group on Outcomes Research in Cardiovascular Disease. Circulation. 2005;111:3158–66.[Abstract/Free Full Text]

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