ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary

Präoperative Evaluation erwachsener Patienten vor elektiven, nicht Herz-Thorax-chirurgischen Eingriffen

“…Grundlagen jeder präoperati-ven technischen Untersuchung sind da-Tab. 1 Akut symptomatische Herzerkrankungen ("active cardiac condition" nach [7] Bei größeren Operationen besteht zudem ein Zusammenhang zwischen Mangelernährung und postoperativer Morbidität und Letalität. Die Erfassung des Ernährungsstatus bzw.…”

“…Revised Cardiac Risk Index (nach [7,8] NRS 2002) sollte daher bei V. a. Mangelernährung (häufiger Indikator: BMI < 18.5 kg/m 2 ) Teil der präoperativen Untersuchung sein [6].…”

Preoperative evaluation of adult patients before elective, noncardiothoracic surgery

“…The basis of every preoperative technical test is a thorough medical history including bleeding history Der Anaesthesist Table 1 Active cardiac conditions according to [7] Acute coronary syndrome Unstable or severe angina (CCS III or IV); recent myocardial infarction (>7 days and <30 days)…”

“…If there are no indications of a preexisting disease which could poten- Table 3 Cardiac risk factors according to theRevisedCardiacRiskIndex(adaptedfrom [7,8] Risk factors are assessed on the basis of medical history or clinical records. The probability of serious cardiac complications increases significantly with an increasing number of risk factors (0.4, 0.9, 6.6, and 11% with 0, 1, 2 and 3 or more risk factors, respectively) CHD coronary heart disease, TIA transient ischemic attack tially have an impact on perioperative procedures, further tests are not necessary-regardless of the type and duration of surgery and age of the patient.…”

“…Rational evaluation of the perioperative cardiovascular risk as well as the decision for or against extended diagnostic testing is based upon the factors described in section A.2.1. In patients with an active cardiac condition (e. g. ST elevation myocardial infarction, STEMI), the surgery-with the exception of emergencies-must be delayed, and the cardiac situation clarified and treated preoperatively [7]. This is, in principle, also valid for patients with non-STEMI (NSTEMI); however, in this case the urgency of the surgery must be weighed up against the urgency of the coronary diagnostics and treatment.…”