Time-of-day dependent effects of midazolam administration on myocardial injury in non-cardiac surgery.
Time-of-day dependent effects of midazolam administration on myocardial injury in non-cardiac surgery.
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DOI：
10.3389/fcvm.2022.982209
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发表时间：
2022
影响因子：
3.6
通讯作者：
Eckle, Tobias
中科院分区：
文献类型：
--
作者：
Prin, Meghan;Pattee, Jack;Douin, David J.;Scott, Benjamin K.;Ginde, Adit A.;Eckle, Tobias
关键词：
动物研究表明，咪达唑仑可能通过昼夜节律调节机制增加对心肌缺血的易感性。我们假设围手术期给予咪达唑仑与非心脏手术(MINS)患者心肌损伤发生率的增加有关，并且昼夜生物学可能是这种关系的基础。我们分析了来自多中心围术期结局小组的术中数据，分析了从2014年到2019年50家机构发生MINS的情况。主要结果是MINS的发生。MINS定义为从麻醉开始到麻醉结束72h，肌钙蛋白I的实验室值至少有一个≥为0.03 ng/ml。为了说明偏倚，采用了倾向性评分和治疗权重的逆概率。共有1,773,118个病例可供分析。在这些受试者中，951,345人(53.7%)围手术期接受咪达唑仑治疗，16,404人(0.93%)符合围手术期MIN标准。在整个研究人群中，围手术期应用咪达唑仑与MINS风险之间没有关联(优势比(OR)0.98，可信区间(CI)[0.94，1.01])。然而，我们发现，当手术发生在夜间(OR 3.52，CI[3.10，4.00])或当手术发生在ASA 1或2患者时(OR 1.25，CI[1.13，1.39])，咪达唑仑的使用与MINS的风险有很强的相关性。围手术期应用咪达唑仑可能不会对MINS的发生构成重大风险。然而，在夜间和更健康的患者中使用咪达唑仑可能会增加MINS，这值得进一步的临床研究，重点是昼夜生物学。
Animal studies have shown that midazolam can increase vulnerability to cardiac ischemia, potentially via circadian-mediated mechanisms. We hypothesized that perioperative midazolam administration is associated with an increased incidence of myocardial injury in patients undergoing non-cardiac surgery (MINS) and that circadian biology may underlie this relationship. We analyzed intraoperative data from the Multicenter Perioperative Outcomes Group for the occurrence of MINS across 50 institutions from 2014 to 2019. The primary outcome was the occurrence of MINS. MINS was defined as having at least one troponin-I lab value ≥0.03 ng/ml from anesthesia start to 72 h after anesthesia end. To account for bias, propensity scores and inverse probability of treatment weighting were applied. A total of 1,773,118 cases were available for analysis. Of these subjects, 951,345 (53.7%) received midazolam perioperatively, and 16,404 (0.93%) met criteria for perioperative MINS. There was no association between perioperative midazolam administration and risk of MINS in the study population as a whole (odds ratio (OR) 0.98, confidence interval (CI) [0.94, 1.01]). However, we found a strong association between midazolam administration and risk of MINS when surgery occurred overnight (OR 3.52, CI [3.10, 4.00]) or when surgery occurred in ASA 1 or 2 patients (OR 1.25, CI [1.13, 1.39]). Perioperative midazolam administration may not pose a significant risk for MINS occurrence. However, midazolam administration at night and in healthier patients could increase MINS, which warrants further clinical investigation with an emphasis on circadian biology.
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影响因子：
3.1
作者：
Oyama Y;Bartman CM;Gile J;Sehrt D;Eckle T
通讯作者：
Eckle T
影响因子：
5.7
作者：
Colquhoun DA;Shanks AM;Kapeles SR;Shah N;Saager L;Vaughn MT;Buehler K;Burns ML;Tremper KK;Freundlich RE;Aziz M;Kheterpal S;Mathis MR
通讯作者：
Mathis MR
DOI：
10.1164/rccm.201312-2291oc
发表时间：
2014-06-01
影响因子：
24.7
作者：
Lonardo, Nick W.;Mone, Mary C.;Barton, Richard G.
通讯作者：
Barton, Richard G.
影响因子：
82.9
作者：
通讯作者：
--
影响因子：
3.6
作者：
Gao, Linggen;Chen, Lei;He, Jing;Wang, Bin;Liu, Chaoyang;Wang, Rong;Fan, Li;Cheng, Rui
通讯作者：
Cheng, Rui