/ Prof Brian O'Brien
Brian O’Brien is from Dublin and is a consultant in anaesthesia and intensive care medicine at Cork University Hospital, where he is chairman of department. He graduated from University College Dublin in medicine, and with a Master’s degree in physiology.
He trained in anaesthesia and intensive care medicine in Ireland and in Melbourne. He is a Fellow of the College of Anaesthetists of Ireland, of the Joint Faculty of Intensive Care Medicine of Ireland, and of the College of Intensive Care Medicine of Australia and New Zealand. He practices cardiac, obstetric and neuro-anaesthesia as well as intensive care medicine. As a member of the Council at the College of Anaesthetists of Ireland, he has served as Chairman of the Training Committee for the last year.
Myocardial protection during non-cardiac surgery.
As ischemic heart disease is common, and surgery represents a major physiological stress, it is clear that the peri-operative period is one of elevated risk for myocardial injury. Recent diagnostic advances have allowed an evolution from crude predictive risk indices to blood tests which can detect occult myocardial injury with great sensitivity, albeit retrospectively. Equally, therapeutic advances have allowed those with heart disease to live longer, more productive lives. In conjunction these developments raise challenges for practicing anaesthetists. Firstly there is the matter of when we should seek signs of subtle myocardial ischemia, and of how we ought to interpret such evidence when we find it.
This question can be considered at the level of the population, as much as in the individual patient. And secondly there is the question of how to treat those in whom there is overt ischemic heart disease, raising questions about the timing of surgery, potential interruption of drug therapy, and the need for pre-operative investigation.
The increasing heterogeneity of the population makes generalisation about treatment more difficult, and indeed some studies have produced findings that are hard to reconcile with others. Such data are outlined in this lecture, and relevant guidelines are discussed in an attempt to allow clinically useful conclusions to be drawn.