Pierre Foex

Pierre Foex
University of Oxford | OX · Nuffield Division of Anaesthetics (NDA)

DM (Geneva), DPhil (Oxon), FRCA, FANZCA, FCA(SA), FMedSci

About

359
Publications
68,692
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8,193
Citations
Citations since 2017
8 Research Items
1208 Citations
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2017201820192020202120222023050100150200
2017201820192020202120222023050100150200

Publications

Publications (359)
Article
Full-text available
p>Background:: Recent data suggest that beta blockers are associated with increased perioperative risk in hypertensive patients. We investigated whether beta blockers were associated with an increased risk in elderly patients with raised preoperative arterial blood pressure. Methods: We conducted a propensity-score-matched cohort study of primary c...
Article
Within the last generation, the management of patients with heart disease has been transformed by advances in drug treatments, interventions and diagnostic technologies. The management of arterial hypertension saw beta-blockers demoted from first- to third-line treatment. Recent studies suggest that the goal of treatment may have to change to lower...
Article
Background: Preoperative blood pressure (BP) thresholds associated with increased postoperative mortality remain unclear. We investigated the relationship between preoperative BP and 30-day mortality after elective non-cardiac surgery. Methods: We performed a cohort study of primary care data from the UK Clinical Practice Research Datalink (2004...
Chapter
Once considered to confer cardiac protection, perioperative betablockade is now regarded as potentially harmful as reduction of cardiac complications is associated with increased all-cause mortality and increased risk of strokes. Over the past decades relatively small studies were not powered enough to detect relatively rare complications, thus all...
Article
Recent growing evidence suggests that beta-blockers treatment could improve cardiovascular dynamics and possibly the outcome of patients admitted to intensive care with severe sepsis or septic shock. Systematic review. MEDLINE and EMBASE healthcare databases. To investigate this topic, we conducted a systematic review of the above databases up to M...
Article
Full-text available
Abstract BACKGROUND: Myocardial dysfunction may contribute to the haemodynamic instability which accompanies sepsis, and may result in circulatory failure. There is no association between systolic dysfunction (SD) and mortality in septic patients and there is conflicting evidence regarding the effects of diastolic dysfunction (DD) on mortality in s...
Article
Abstract BACKGROUND: Myocardial dysfunction may contribute to the haemodynamic instability which accompanies sepsis, and may result in circulatory failure. There is no association between systolic dysfunction (SD) and mortality in septic patients and there is conflicting evidence regarding the effects of diastolic dysfunction (DD) on mortality in s...
Article
Full-text available
Atenolol has been proposed as a peri-operative cardioprotective agent in patients with coronary disease. However, recent reports have cast doubt over the cardioprotective efficacy of atenolol in patients with hypertension and coronary artery disease. There is therefore doubt whether atenolol is the correct cardioprotective drug in the surgical sett...
Article
The number of percutaneous coronary interventions (PCI) performed annually has increased rapidly over the last two decades. Coronary angioplasties are now commonly complemented with the insertion of coronary artery stents. Initially bare metal stents (BMS) were developed with drug-eluting stents (DES) subsequently being introduced. Drug-eluting ste...
Article
The perioperative use of beta-blockers (BBs) with the aim of decreasing perioperative adverse cardiac events has been strongly supported, especially after the publication of two small trial (McSPI and DECREASE I) that showed major benefits. However, some later trials did not confirm these benefits. The POISE trial, with 8351 patients, showed reduce...
Article
Quint and colleagues recently published the results of their investigation into the role of β blockers in patients with chronic obstructive pulmonary disease (COPD) having a first myocardial infarction.1 They obtained data from the UK national registry of myocardial infarction between 2003 and 2008. The primary outcome of all …
Article
The perioperative use of betablockers (BBs) with the aim of decreasing perioperative adverse cardiac events has been strongly supported, especially after the publication of two small trial (McSPI and DECREASE I) that showed major benefits. However, some later trials did not confirm these benefits. The POISE trial, with 8.351 patients, showed reduce...
Article
Full-text available
Background This post hoc analysis aimed to determine whether neuraxial block was associated with a composite of cardiovascular death, non-fatal myocardial infarction (MI) and non-fatal cardiac arrest within 30 days of randomization in POISE trial patients.MethodsA total of 8351 non-cardiac surgical patients at high risk of cardiovascular complicati...
Article
Background: In this post hoc subanalysis of the Perioperative Ischemic Evaluation (POISE) trial, we sought to determine whether nitrous oxide was associated with the primary composite outcome of cardiovascular death, nonfatal myocardial infarction (MI), and nonfatal cardiac arrest within 30 days of randomization. Methods: The POISE trial of peri...
Article
There is uncertainty regarding the prognostic value of troponin and creatine kinase muscle and brain isoenzyme measurements after noncardiac surgery. The current study undertook a systematic review and meta-analysis. The study used six search strategies and included noncardiac surgery studies that provided data from a multivariable analysis assessi...
Article
Full-text available
BACKGROUND:The effect of carotid endarterectomy in lowering the risk of stroke ipsilateral to severe atherosclerotic carotid-artery stenosis is offset by complications during or soon after surgery. We compared surgery under general anaesthesia with that under local anaesthesia because prediction and avoidance of perioperative strokes might be easie...
Article
Statins are widely used in the prevention of atheromatous disease and its complications. While their lipid lowering effects are very important, there is increasing emphasis on the other effects of statins described as pleiotropic. These include atheromatous plaque stabilisation generally ascribed to their anti-inflammatory properties. It is increas...
Chapter
Full-text available
In 1997, the American College of Physicians published a guideline for assessing and managing patients with coronary artery disease who undergo major noncardiac surgery [1]. An important recommendation was that all eligible patients should receive a beta-blocker (atenolol).
Article
Full-text available
Acute perioperative beta-adrenergic blockade may be cardioprotective in the high-risk cardiac patient for major non-cardiac surgery. We have investigated the association between the heart rate achieved with perioperative beta-blockade and the incidence of perioperative cardiac complications. We identified eight randomized studies (1931 patients) re...
Article
Full-text available
The utility of interventional cardiology has developed significantly over the last two decades with the introduction of coronary angioplasty and stenting, with the associated antiplatelet medications. Acute coronary stent occlusion carries a high morbidity and mortality, and the adoption of therapeutic strategies for prophylaxis against stent throm...
Chapter
Full-text available
In the United States there are 4.9 million people with heart failure, 50% of whom will be dead within 5 years. There are also over 400 000 new cases reported annually [1], with approximately 43 000 deaths. The number of hospital admissions resulting from heart failure approaches 900 000 per annum and represents 20% of all admissions of patients ove...
Chapter
Full-text available
Cardiovascular complications of anesthesia and surgery remain, unfortunately, very frequent. In the USA, Mangano and Goldman concluded that approximately 27 million anesthetics were given every year, including 8 million to patients with coronary artery disease. They estimated the number of cardiovascular complications to be approximately 1 million...
Article
Full-text available
Atherosclerosis is a common condition in both the developed and developing world and is now recognised to be an inflammatory condition leading to the development of ischaemic heart disease, cerebrovascular disease and peripheral vascular disease. Ischaemic heart disease is a major risk factor in the pathogenesis of perioperative adverse cardiovascu...
Article
Full-text available
We conducted a pharmaco-economic analysis of the prospective peri-operative studies of beta-blocker and statin administration for major elective non-cardiac surgery, using the Discovery Health claims costs for 2004. This analysis shows that acute peri-operative beta-blockade and statin therapy could result in a cost saving through a reduction in ma...
Article
Peri-operative beta-blockade has been shown to reduce the incidence of postoperative cardio- vascular complications including cardiac death in high-risk non-cardiac surgical patients. However, the recent analysis by Lindenauer et al. suggests that it is inappropriate to administer beta-blockers blindly to all surgical patients. In an attempt to det...
Article
It is widely recommended that beta-blockade be used peri-operatively as it may reduce the incidence of postoperative cardiovascular complications including death. However, there are few data concerning the cost-effectiveness of such strategies. We have analysed the pharmacoeconomics of acute beta-blockade using data from eight prospective peri-oper...
Chapter
The effects of myocardial ischaemia on cardiac function have been studied for many years. This is not surprising, as myocardial ischaemia and its consequences are among the leading causes of morbidity and mortality.
Chapter
In the United States, there are 4.9 million people with heart failure and 400 000 new cases are reported annually [1]. A similar prevalence of heart failure exists in northern Europe, while the prevalence of heart disease, particularly coronary heart disease, is lower in southern Europe. As coronary heart disease is amajor cause of cardiac failure,...
Article
We analysed the pharmaco-economics of the prospective peri-operative studies of statin administration for major elective vascular surgery, using the NHS reference costs for 2004. This analysis suggests that peri-operative statin therapy for patients undergoing vascular surgery may present the most cost-effective use of statin therapy yet described,...
Article
Statin cardiovascular protection is mediated by lipid lowering and pleiotropic effects. The efficacy of statins has been established in non-surgical patients with cardiovascular disease and also more recently in non-surgical patients who sustain an acute coronary event. Peri-operative statin administration has been shown to improve both short-term...
Article
The use of beta-blockers in the management of patients with coronary artery disease, arterial hypertension and cardiac failure suggests that they should offer significant protection against perioperative cardiac events. Initiating or continuing beta-blockade in patients presenting for surgery may be regarded as offering protection with no need for...
Article
Though ischaemia/reperfusion injury induces renin-angiotensin systemic (RAS) activation and increased heart angiotensin production, the effects of blockade of the two main angiotensin II receptors, AT1 and AT2, are not definitively established. Using a Langendorff heart preparation, effects of Valsartan 10(-7)M (AT1 receptor blocker), PD 123319 10(...
Article
To assess the incidence of major cardiac events in critically ill patients with a high risk of cardiac complications presenting with an elevated heart rate. Observational, retrospective study in a 15-bed medical/surgical Intensive Care Unit (ICU) at a university hospital for a period of 12 months. We studied patients with a high risk of cardiac com...
Article
Full-text available
We reviewed the pathophysiology and treatment of hypertension in a recent edition of this journal (see key references). In this article, we discuss the management of the hypertensive patient presenting for surgery and anaesthesia.
Article
Little is known about the effect of chronic beta-adrenoceptor antagonist therapy during the peri-operative period in patients undergoing non-cardiac surgery. We conducted a literature review to identify studies examining the relationship between chronic therapy and adverse peri-operative outcome. Eighteen studies were identified in which it was pos...
Article
Full-text available
Arterial hypertension is a major cause of morbidity and mortality because of its association with coronary heart disease, cerebrovascular disease and renal disease. The extent of target organ involvement (i.e. heart, brain and kidneys) determines outcome. North American studies have shown that hypertension is a major contributor to 500 000 strokes...
Article
We have previously demonstrated that the peri-operative measurement of increased serum concentrations of the cardiac markers troponins I and T and creatine kinase-MB can be predictors of major cardiovascular outcomes (including cardiac death) at 3 months after surgery. In the present study, we have followed the postoperative course of 157 patients...
Article
Full-text available
The evidence for an association between hypertensive disease, elevated admission arterial pressure, and perioperative cardiac outcome is reviewed. A systematic review and meta‐analysis of 30 observational studies demonstrated an odds ratio for the association between hypertensive disease and perioperative cardiac outcomes of 1.35 (1.17–1.56). This...
Chapter
The effects of myocardial ischaemia on cardiac function have been studied for many years. This is not surprising as myocardial ischaemia and its consequences are amongst the leading causes of morbidity and mortality.
Chapter
Catecholamines produce a wide range of effects mediated by the activation of adrenoceptors. These receptors have been subclassified into a-and ~-receptors, themselves subdivided into a l-and a,-receptors and ~l-and ~,-receptors respectively.':” Dopaminergic receptors have also been subdivided into two subtypes: the presynaptic D2-and the postsynapt...
Article
Full-text available
The aim of this review of the literature was to evaluate the effectiveness of anesthetics in protecting the heart against myocardial ischemia-reperfusion injury. Articles were obtained from the Medline database (1980-, search terms included heart, myocardium, coronary, ischemia, reperfusion injury, infarction, stunning, halothane, enflurane, desflu...
Article
Two hundred and seventy-five non-cardiac surgical patients were recruited to determine risk factors associated with the development of postoperative cardiovascular complications during the first year after surgery. Patients underwent ambulatory electrocardiography pre- and postoperatively. There were 34 adverse events over the whole study period. T...
Article
Volatile anaesthetics can pharmacologically enhance the recovery of stunned myocardium, but the mechanism is still unknown. This study sought to determine whether isoflurane attenuates myocardial stunning, and whether the myocardial protection of isoflurane is mediated by adenosine A1 receptors. Five groups (n=8) of isolated rat hearts were studied...
Article
Editor—Rodgers et al report a meta-analysis of 141 trials comparing general anaesthesia with neuraxial blocks.1 They conclude that their data should result in more widespread use of spinal or epidural anaesthesia. The challenge for clinicians is deciding which of their patients (if any) these results apply to, but Rodgers et al provided little info...
Article
Full-text available
The Oxford Record Linkage Study (ORLS; an epidemiological database) was used to examine relationships between intercurrent cardiovascular drug therapy and cardiac death within 30 days of elective or emergency/urgent surgery under general anaesthesia. Cases identified from the ORLS were paired with matched control patients. Clinical details were obt...
Chapter
Full-text available
Anaesthesia, the single largest hospital medical speciality, has expanded to include anaesthesia, acute and chronic pain relief and intensive care. Over 60 per cent of hospital patients are in contact with anaesthetists. Developments over the past decades have increased its safety and its mechanisms have become clearer. Many anaesthetists are becom...
Article
Both mitochondrial adenosine triphosphate-sensitive potassium (MKATP) channels (selectively blocked by 5-hydroxydecanoate) and stretch-activated channels (blocked by gadolinium) have been involved in the mechanism of ischemic preconditioning. Isoflurane can reproduce the protection afforded by ischemic preconditioning. We sought to determine whethe...
Article
An IBM PC-based real-time data acquisition, monitoring and analysis system for experimental haemodynamic studies was developed. Comprehensive haemodynamic signals, such as aortic and left ventricular pressures, aortic and coronary blood flows, two segmental lengths, two segmental thicknesses, electrocardiogram and airway pressure, were acquired and...
Article
We investigated the use of measurements of serum concentrations of the cardiac proteins troponins I and T as biochemical markers of myocardial cell damage in 80 patients undergoing vascular or major orthopaedic surgery. Holter electrocardiographic monitoring was carried out before surgery and for 3 days after surgery. Blood samples for troponins I...
Article
Full-text available
Langendorff rat hearts were used (i) to examine whether fentanyl reduces stunning, infarction or both, and (ii) to investigate if this protection is mediated by δ-opioid receptors and/or protein kinase C (PKC). In the stunning study, hearts were subjected to global ischaemia (20 min) and reperfusion. This did not produce infarction. Postischaemic m...
Article
We have examined observational data from four published studies investigating the incidence of postoperative silent myocardial ischaemia (post-SMI) for the effects of chronic intercurrent therapy with beta-adrenoceptor blockade or chronic calcium channel entry blockade. A total of 453 patients underwent ambulatory ECG monitoring before and for 2 da...
Article
Full-text available
We have investigated if fentanyl protects against myocardial ischaemic injury and if so, if the mechanism of this protection is mediated via opioid and adenosine A1 receptors, and KATP channels. Langendorff rat hearts were subjected to global ischaemia (30 min) and reperfusion (60 min). The drugs were administered before induction of ischaemia and...
Article
Cardiovascular complications of anaesthesia and surgery remain frequent and have short- and long-term consequences. Identification of high-risk patients is an essential step in the management of patients with cardiovascular disease who are not always fully investigated before admission for non-cardiac surgery. Clinical risk indices allow the risk o...
Chapter
Over the last fifty years, mortality caused by anesthesia alone has decreased from one in 1500 to one in 150 000 or less. However, the peri-operative mortality of anesthesia and surgery continues to be a major public health issue, as well as the frequent occurrence of major cardiovascular complications including myocardial ischemia, unstable angina...
Article
This study was designed to examine the effect of volume loading on haemodynamic responses and regional cardiac function in dogs subjected to two infusion rates of propofol. Instrumentation was established to measure aortic and left ventricular pressures, cardiac output and myocardial segmental lengths. Measurements were taken during two successive...
Article
Myocardial ischaemia occurs frequently during the peri-operative period and is associated with major cardiac events in patients with silent or overt coronary artery disease. Often caused by an imbalance between excessive oxygen demand and limited oxygen supply, ischaemia may also occur as a result of endothelial dysfunction in diseased coronary art...
Article
Previous work showed a twofold increase in stiffness of nonischemic myocardium at the base during ischemia of the left anterior wall. Whether the diastolic response of nonischemic myocardium to remote ischemia depends on the localization of the ischemic or the nonischemic area is unknown. In dogs with open chests, regional function in ischemic and...
Article
The Oxford Record Linkage Study (an epidemiological database) was used to identify patients who died from a cardiovascular cause within 30 days of emergency or urgent surgery under general anaesthesia. Each case was paired with a control patient (matched for age within 10 yr of the patient, operation and consultant). Additional clinical information...
Article
Nonischemic end-systolic performance decreases during ischemia. These changes in performance are likely to be dependent on the size and site of the ischemic zone, as well as the prevailing loading conditions. This study was designed to examine the effect of regional and generalized changes in inotropy on nonischemic end-systolic performance, indepe...

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