Cardiac Evaluation and Monitoring of Patients Undergoing Noncardiac Surgery

Abstract

Surgical management of disease has a tremendous impact on our health system. Millions of people worldwide undergo surgeries every year. Cardiovascular complications in the perioperative period are one of the most common events leading to increased morbidity and mortality. Although such events are very small in number, they are associated with a high mortality rate making it essential for physicians to understand the importance of perioperative cardiovascular risk assessment and evaluation. Its involves a detailed process of history taking, patient’s medical profile, medications being used, functional status of the patient, and knowledge about the surgical procedure and its inherent risks. Different risk assessment tools and calculators have also been developed to aid in this process, each with their own advantages and limitations. After such a comprehensive evaluation, a physician will be able to provide a risk assessment or it may all lead to further testing if it is believed that a change in management after such testing will help to reduce perioperative morbidity and mortality. There is extensive literature on the significance of multiple perioperative testing modalities and how they can change management. The purpose of our review is to provide a concise but comprehensive analysis on all such aspects of perioperative cardiovascular risk assessment for noncardiac surgeries and provide a basic methodology toward such assessment and decision making.

Perioperative Preparation of Cardiac Patients in Regional Anesthesia

“…In case DAPT has to be discontinued for urgent or emergent surgery, such a decision should be individualized, weighting risks and benefits. 11 Discontinuation of aspirin may be responsible for 15% of all recurrent acute coronary syndromes in patients with documented stable coronary artery disease. Aspirin taken for secondary cardiac prevention should, in general, not be discontinued.…”

“…Depending on the result of the stress test, patients proceed to coronary revascularization and then proceed for the surgery on optimal therapy. ( 11 )…”

“…In case DAPT has to be discontinued for urgent or emergent surgery, such a decision should be individualized, weighting risks and benefits. ( 11 )…”

Accepting a chronic kidney disease patient for perioperative management: a narrative review of key aspects

“…35 However, mere presence of a serum creatinine level of > 1.5 or 2 mg/dl does not indicate that the patient may be at high risk if the patient is relatively young and not having other comorbidity or complications, and these patients can safely proceed for non-cardiac surgeries without further cardiac evaluation. 38,40 However, the scenario is not so rosy, especially in the low socioeconomic and developing countries where a good number of CKD patients present for the first time to the hospital with advanced grade/end stage renal disease. If the cause of the CKD is diabetes and the patient is either elderly or presenting with heart failure features, they will need further cardiac evaluation and optimization.…”

Perioperative arrhythmias

“…Patients in the risk group should have detailed assessment and then consultation with cardiology and it is important to prepare the patient in the best conditions for surgery and share risks based on this recommendation. Situations like acid-base balance disorder, electrolyte imbalances, cardiac pathologies, hypoxia and variations in body temperature that prepare the way for arrhythmias should be resolved at optimum levels to ensure the patient is stable (Rafiq et al, 2017). With regional anesthesia, patients should be more closely monitored for hypotension, bradycardia and sudden cardiac arrest, with patients monitored for rhythm, respiration and hemodynamics during every type of anesthesia administration.…”