Predictive Value of Preoperative Electrocardiographic Monitoring

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Abstract
The study by Raby et al. (Nov. 9 issue)* describes the predictive value of preoperative electrocardiographic monitoring for ischemia in patients undergoing peripheral vascular surgery. Although the authors analyzed an impressive list of potentially confounding variables, we were surprised at the absence of any discussion of the management of anesthesia or its effect on postoperative ischemic events, which might well affect the perioperative outcome in these high-risk patients. We would appreciate further elucidation on several points. Was the anesthesiologist also blinded to the presence of preoperative ischemia? If not, did the preoperative ischemic status affect the choice of monitoring and therapy? Was there a standard management of anesthesia for all patients? If not, was the type of anesthesia randomly assigned to patients with and those without ischemia? Finally, what proportion of the patients in each group had intraoperative ischemic changes on their electrocardiograms, and how was intraoperative ischemia treated?