Evaluation of the Cardiac Status of the Poor Risk Patient

Influence of previous therapy on anesthesia

“…Questions arise, however, regarding the ability of these drugs to produce arrhythmias and over the value of prophylactic digitalization. 147 Thus, it has been said on the basis of clinical experience that the combination of digitalization and general anesthesia often produces a more irritable myocardium. 17 Animal experimentation indicates that the over digitalized heart may be more sensitive to epinephrine-induced arrhythmias,163 but cyclopropane tends to improve leO , 163 and ether to abolish 120 digitalis-induced arrhythmias.…”

Practical Considerations in the Management of the Geriatric Surgical Patient

“…A good result may be secured even in the presence of acute coronary occlusion or congestive heart failure when operation is obligatory. In less crucial instances, however, surgery should generally not be attempted within ninety days of the occurrence of coronary thrombosis, since it is estimated that about that length of time is required for the infarct to heal completely (91). Ostensibly, the heart would be expected to tolerate surgery better after healing had been accomplished.…”

“…Ostensibly, the heart would be expected to tolerate surgery better after healing had been accomplished. Rutledge (91) states that hypertension, even if severe, increases only slightly the risk of major surgical procedures, but this assertion remains unsubstantiated.…”

“…Although it is agreed that cardiac glycosides should be given promptly in cases in which incipient heart failure or arrhythmias present themselves (43, 91, 138), their routine use preoperatively as recommended by Christian (139) awaits further trial. Raisbeck (140) has discussed the indications and dosage considerations in the use of digitalis preparations in the aged.…”