Preoperative evaluation of patients with, or at risk of, coronary artery disease undergoing non-cardiac surgery

Abstract

The increasing number of patients with coronary artery disease undergoing major non-cardiac surgery justifies guidelines concerning preoperative evaluation, stress testing, coronary angiography, and revascularization. A review of the recent literature shows that stress testing should be limited to patients with suspicion of a myocardium at risk of ischaemia, and coronary angiography to situations where revascularization can improve long-term survival. Recent data have shown that any event in the coronary circulation, be it new ischaemia, infarction, or revascularization, induces a high-risk period of 6 weeks, and an intermediate-risk period of 3 months. A 3-month minimum delay is therefore indicated before performing non-cardiac surgery after myocardial infarction or revascularization. However, this delay may be too long if an urgent surgical procedure is requested, as for instance with rapidly spreading tumours, impending aneurysm rupture, infections requiring drainage, or bone fractures. It is then appropriate to use perioperative beta-block, which reduces the cardiac complication rate in patients with, or at risk of, coronary artery disease. The objective of this review is to offer a comprehensive algorithm to help clinicians in the preoperative assessment of patients undergoing non-cardiac surgery.

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

“…31 The ACC/AHA guidelines maintained the same weakness, as evident by several publications of the ACC/AHA algorithm as a simplified formula. [32][33][34] These publications present a graphic model 32 or a mathematical calculation 33,34 of the ACC/AHA algorithm designed for easy daily use by the physician, who has to decide whether or not a patient requires further cardiac evaluation.…”

A Successful Administration of Anesthesia in An Urgent Spinal Surgery of a Patient with a High Risk of Coronary Artery and Degenerative Cardiac Valvular Diseases

“…Kalp dışı cerrahi işlem uygulanacak bir kalp hastasının başarılı preoperatif değerlendirilmesi ve tedavisi için hasta, cerrah, anestezist ve kardiyolog arasında iyi bir iletişim ve işbirliği gerekmektedir (1)(2)(3)(4)(5) . Perioperatif dönemde kalp dışı cerrahi hastasının değerlendirilmesi temelde ameliyatın aciliyeti, yapı-lacak cerrahinin tipi, risk faktörlerinin varlığı gibi ek faktörlere bağlıdır.…”

“…Bu haliyle ameliyata alınmasına karar verildi. Hasta ASA (American Society of Anesthesiologists) fiziksel durum sınıflandır-masına göre IV, Goldman kardiyak risk sınıflamasına göre sınıf III, Detsky risk sınıflamasına göre sınıf III ve cerrahi risk bakımından majör prosedür olarak değerlendirildi (2)(3)(4) . Ameliyathanede invaziv arter monitörizasyonu yapıldı.…”

Is there an effect of perioperative blood pressure on intraoperative complications during phacoemulsification surgery under local anaesthesia?

“…4 Recent studies also cast considerable doubt that the perioperative outcome is worse in hypertensive than in normotensive patients in most clinical situations. 5,6 Howell et al 5 noted a tendency for an increased incidence of perioperative haemodynamic instability, myocardial ischaemia, and cardiac arrhythmias in patients with severe hypertension (systolic blood pressure (SBP) 4180 mm Hg, diastolic blood pressure (DBP) 4110 mm Hg) undergoing surgery under general anaesthesia. There is thus little evidence between admission arterial pressures of o180 mm Hg systolic or 110 mm Hg diastolic and perioperative complications.…”