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Extra info for The Washington Manual of Medical Therapeutics
Preoperative anemia, hematocrit <39% in men and <36% in women, is independently associated with an increase in 30-day morbidity/mortality risk. (Lancet 2011 Oct 15;378(9800)). 25 Postoperatively, in a cohort of patients who refused transfusion, no mortality was observed for hemoglobin >7 g/dL. A marked increase in risk was seen at hemoglobin <5 g/dL threshold (Transfusion 2002;42:812). The benefit of transfusion at physiologically tolerable levels of anemia is unclear. com/ The TRICC trial, a study of intensive care unit patients, showed no mortality difference between transfusion thresholds of hemoglobin <7 g/dL or <10 g/dL.
MONITORING/FOLLOW-UP Postoperative Infarction and Surveillance Most events will occur within 48-72 hours of surgery, with the majority in the first 24 hours (CMAJ 2005;173:779). Most are not heralded by chest pain and may be clinically asymptomatic (Anesthesiology 1990;72:153). Although overall 30-day mortality has been linked to postoperative troponin elevation (JAMA 2012;307:2295), the cause of death is not predictable, and no specific course of therapy may be offered. The 2014 ACC/AHA (Circulation 2014;130;e278) guidelines offer the following: Routine postoperative ECGs and troponins are not recommended.
32 However, certain additional factors have to be considered when evaluating the cause in the perioperative setting: Intraoperative hemodynamic changes, particularly hypotension, should be considered. Intraoperative factors associated with ARF postoperatively include vasopressor use and diuretic use (Anesthesiology 2007;107:892). A careful review of the operative record is advised. , aortic clamping procedures). Therefore, careful attention to the details of the procedure is necessary. The possibility that bleeding is responsible for a prerenal state deserves special attention.