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April 28, 1993

The Cardiac Risks of Noncardiac Surgery

JAMA. 1993;269(16):2083. doi:10.1001/jama.1993.03500160049014

To the Editor.  —The title of the recent Editorial,1 "Anesthesia and Major Noncardiac Surgery," is incomplete since the articles being discussed used specifically inhalational and intravenous anesthesia to the exclusion of regional anesthesia. The reports state that the study group was made up of patients "requiring general anesthesia," which neglects the option, available in almost all cases, of adding neural blockade to general anesthesia.A growing body of evidence shows that adverse perioperative outcomes are caused by uncontrolled stress responses. Virtually every organ system is to some degree protected from surgical stress by blocking afferent neural signals with intraoperative and postoperative regional anesthetic techniques. Dr Killip questions whether we can alter outcomes; neural blockade is effective2,3 and available, yet only used occasionally. Perhaps this is because reimbursement is more readily available to anesthesiologists for the relatively easy task of conveying the patient through the operative event than the