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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
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