Postoperative myocardial ischemia. Therapeutic trials using intensive analgesia following surgery. The Study of Perioperative Ischemia (SPI) Research Group.

Recent data suggest that postbypass and postoperative myocardial ischemia are related to adverse cardiac outcome following myocardial revascularization. Therapeutic trials to suppress postoperative ischemia are warranted. Because anesthetics can suppress a variety of physiologic responses to stress as well as myocardial ischemia intraoperatively, we examined whether use of intensive analgesia in the stressful postoperative period could decrease postoperative ischemia.

Isoflurane anesthesia and myocardial ischemia: comparative risk versus sufentanil anesthesia in patients undergoing coronary artery bypass graft surgery. The SPI (Study of Perioperative Ischemia) Research Group.

Whether isoflurane has the potential to produce coronary artery steal and associated myocardial ischemia is still controversial. Previous studies addressing this issue in humans did not purposefully control hemodynamics or use continuous measures of myocardial ischemia. The authors used transesophageal echocardiography (TEE) and continuous Holter electrocardiography (ECG) to study the relative risk of myocardial ischemia during isoflurane or sufentanil anesthesia under strict control of hemodynamics in 186 high-risk patients undergoing elective coronary artery bypass graft (CABG) surgery.

A comprehensive treatment program for severely impaired geriatric patients.

Many elderly patients have psychiatric and medical needs that are not met by the traditional care offered at state hospitals, acute psychiatric services, or nursing homes. At Garfield Geropsychiatric Hospital, a program of intensive evaluation and multidisciplinary treatment that emphasizes rehabilitation has been successful in maintaining or restoring independent functioning for severely impaired geriatric patients. The program also benefits the mental health system by reducing the inappropriate use of state hospital and acute psychiatric services, and by providing a first important step toward a comprehensive network of mental health services for the elderly.