The role of stress hormones in perioperative myocardial ischemia.

In this chapter I have tried to illustrate how trauma-induced changes in plasma catecholamines and other stress hormones can result in physiological alterations that may in turn increase the likelihood of developing myocardial ischemia. Data have been presented about potential mechanisms by which these hormones can lead to the development of ischemia, although additional work is required in this area. Among the strategies for modulating the stress response to surgery, the use of axial narcotics and perioperative administration of alpha 2-agonists can be easily instituted in most institutions. Additional studies are needed to determine whether these techniques reduce the incidence of perioperative ischemic complications. Because these interventions are labor intensive and therefore costly, further work is required to identify which subsets of patients may benefit from such aggressive management.