Preoperative Assessment of Patients with Known or Suspected Coronary Disease

Mangano, Dennis T.; Goldman, Lee

doi:10.1056/nejm199512283332607

Cited by 378 publications

(133 citation statements)

References 66 publications

(102 reference statements)

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“…One approach is to confine routine use of noninvasive testing to patients with moderate risk for complications (eg, classes III or IV). 3 An alternative strategy has been suggested by Bodenheimer,12 who argues that improved outcomes are more likely to result from controlling postoperative oxygen demand than additional risk stratification. This approach would support use of this index to identify patients who should be treated with strategies to reduce oxygen consumption rather than undergo additional noninvasive testing.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Risk stratification of these patients often relies on noninvasive tests for myocardial ischemia, but analyses suggest that test results are most useful in patients whose clinical data suggest moderate risks for complications and that they have limited impact in high-or low-risk groups. [3][4][5] Among the tools for clinical risk stratification are the Cardiac Risk Index 6 and other decision aids. 7 Recent guidelines have recommended a modification of the Cardiac Risk Index, 8,9 but the studies used to develop this and other prior decision aids have relied on small numbers of patients, and they predated recent advances in surgery and anesthesia.…”

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Derivation and Prospective Validation of a Simple Index for Prediction of Cardiac Risk of Major Noncardiac Surgery

et al. 1999

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Background —Cardiac complications are important causes of morbidity after noncardiac surgery. The purpose of this prospective cohort study was to develop and validate an index for risk of cardiac complications. Methods and Results —We studied 4315 patients aged ≥50 years undergoing elective major noncardiac procedures in a tertiary-care teaching hospital. The main outcome measures were major cardiac complications. Major cardiac complications occurred in 56 (2%) of 2893 patients assigned to the derivation cohort. Six independent predictors of complications were identified and included in a Revised Cardiac Risk Index: high-risk type of surgery, history of ischemic heart disease, history of congestive heart failure, history of cerebrovascular disease, preoperative treatment with insulin, and preoperative serum creatinine >2.0 mg/dL. Rates of major cardiac complication with 0, 1, 2, or ≥3 of these factors were 0.5%, 1.3%, 4%, and 9%, respectively, in the derivation cohort and 0.4%, 0.9%, 7%, and 11%, respectively, among 1422 patients in the validation cohort. Receiver operating characteristic curve analysis in the validation cohort indicated that the diagnostic performance of the Revised Cardiac Risk Index was superior to other published risk-prediction indexes. Conclusions —In stable patients undergoing nonurgent major noncardiac surgery, this index can identify patients at higher risk for complications. This index may be useful for identification of candidates for further risk stratification with noninvasive technologies or other management strategies, as well as low-risk patients in whom additional evaluation is unlikely to be helpful.

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Section: Discussionmentioning

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confidence: 99%

Derivation and Prospective Validation of a Simple Index for Prediction of Cardiac Risk of Major Noncardiac Surgery

et al. 1999

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“…A host of studies have dictated the workup of the cardiac patient for detecting those who deserve further investigation while avoiding the unnecessary testing of others. 5,6,30 The more a study was detailed and tried to answer every possible clinical circumstance, the more complex and difficult to pursue it became. Even the historic article by Goldman et al 17 on cardiac risk stratification was criticized as being "cumbersome in any attempt to evaluate the resulting risk or to discuss it with the patient or family."…”

Section: Guidelines Complexitymentioning

confidence: 99%

ACC/AHA guidelines for preoperative cardiovascular evaluation for noncardiac surgery: A critical point of view

Barák

Ben‐Abraham

Katz

2006

Clinical Cardiology

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Summary: This review examines the issue of preoperative cardiac evaluation from a critical point of view, based on recent medical literature. We reviewed the history of that field and focused on the American College of Cardiology and American Heart Association guidelines, which are a cornerstone in the field of cardiac patients undergoing noncardiac surgery. These guidelines synthesized the data into a comprehensive format and established the concept of integrating the patient's risk with the surgical risk. Nevertheless, there are some weaknesses in the guidelines. We believe that a better understanding of the guideline limitations will allow an improved and more educated practice of its recommendations.

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“…As estatinas parecem oferecer efeitos cardioprotetores no período perioperatório, porém são necessários mais estudos antes de recomendá-las como rotina 36,37 . Entretanto, deve-se ter sempre em mente que esses pacientes necessitam de proteção do miocárdio [38][39][40][41][42][43][44][45] .…”

Section: Avaliação E Preparo Pré-anestésicounclassified

Anestesia para intervenção cirúrgica endovascular na aorta abdominal

Lorentz

Boni

Soares

2008

Rev. Bras. Anestesiol.

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Rev Bras AnestesiolARTIGO DE REVISÃO 2008; 58: 5: 520-532 REVIEW ARTICLE RESUMO Lorentz MN, Boni CLA, Soares RR -Anestesia para Intervenção Cirúrgica Endovascular na Aorta Abdominal. JUSTIFICATIVA E OBJETIVOS:O procedimento endovascular para correção de aneurisma de aorta é menos invasivo que o convencional, além de apresentar outras vantagens, como ausência de incisão abdominal, ausência de pinçamento da aorta e menor tempo de recuperação pós-operatória. Por se tratar de procedimento cirúrgico relativamente novo e apresentar uma série de alterações que devem ser conhecidas pelo anestesiologista foi realizado este trabalho com o objetivo de revisar os aspectos mais relevantes do procedimento endovascular e possibilitar manuseio anestésico mais adequado no perioperatório. CONTEÚDO:Apresentação sucinta da técnica cirúrgica para reparo de aneurismas via endovascular, as possíveis vantagens e desvantagens do procedimento, bem como as complicações potenciais. Além disso, foram abordados os cuidados perioperatórios que o procedimento exige e as técnicas anestésicas que podem ser utilizadas. CONCLUSÕES:O conhecimento das alterações provenientes do procedimento endovascular possibilita conduta anestésica mais adequada e melhora dos resultados perioperatórios nesses pacientes.Unitermos: CIRURGIA, Vascular; DOENÇA, Vascular: aneurisma. SUMMARYLorentz MN, Boni CLA, Soares RR -Anesthesia for Endovascular Surgery of the Abdominal Aorta. BACKGROUND AND OBJECTIVES:Endovascular surgery for aneurism of the aorta is less invasive than the conventional procedure besides other advantages such as the absence of abdominal incision, absence of ligature of the aorta, and reduced postoperative recovery time. Since it is a relatively new procedure and to presenting a series of changes that should be known by the anesthesiologist, the objective of this report was to review the most relevant aspects of endovascular surgery, allowing more adequate perioperative anesthetic management. CONTENTS:A brief description of the technique of endovascular aneurism repair, possible vantages and disadvantages of its use, as well as potential complications are discussed. CONCLUSIONS:Knowledge of the changes secondary to the endovascular procedure allows a more adequate anesthetic conduct and improves the postoperative results in those patients.

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Preoperative Assessment of Patients with Known or Suspected Coronary Disease

Cited by 378 publications

References 66 publications

Derivation and Prospective Validation of a Simple Index for Prediction of Cardiac Risk of Major Noncardiac Surgery

Derivation and Prospective Validation of a Simple Index for Prediction of Cardiac Risk of Major Noncardiac Surgery

ACC/AHA guidelines for preoperative cardiovascular evaluation for noncardiac surgery: A critical point of view

Anestesia para intervenção cirúrgica endovascular na aorta abdominal

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