Preoperative evaluation of the cardiac patient for noncardiac surgery.
Perioperative cardiac events continue to represent a significant cause of morbidity in patients undergoing noncardiac surgery. The evaluation of the high risk patient should begin with an assessment of the probability of coronary artery disease and exercise tolerance. Decisions to undergo further evaluation, including noninvasive testing, should be based upon the perioperative morbidity and mortality rate for the planned surgical procedure. In patients with significant coronary artery stenoses and a high probability of perioperative cardiac morbidity, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, and preoperative optimization of hemodynamics in an intensive care unit have all been advocated as means of reducing risk.
Fleisher
L A
LA
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Barash
P G
PG
D003327:Coronary Disease / Q000150:complications*; D005069:Evaluation Studies as Topic; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D011300:Preoperative Care / Q000592:standards*; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000592:standards