Perioperative assessment and management of patients with coronary artery disease.
Primary care physicians, surgeons, and anesthesiologists are all involved in assessing patients before surgery. The medical literature describes techniques to identify high-risk cardiac patients before elective surgery and strategies to reduce risk once these patients have been identified. Multifactorial indices can identify high-risk patients undergoing nonvascular surgery. Selective use of dipyridamole-thallium imaging based on clinical factors will identify high-risk patients before vascular surgery. Once high-risk patients have been identified, risk reduction can be attempted in various ways. We have no convincing evidence that prophylactic revascularization benefits high-risk patients. Perioperative beta-blockade reduces perioperative myocardial ischemia, mortality, and the incidence of cardiovascular complications for up to 2 years. Therefore, perioperative beta-blockers are recommended for high-risk patients undergoing elective noncardiac surgery.
Potyk
D K
DK
University of Washington School of Medicine, Spokane, USA. potykd@shmc.org
D003327:Coronary Disease / Q000175:diagnosis / Q000601:surgery*; D017558:Elective Surgical Procedures; D006801:Humans; D019990:Perioperative Care / Q000379:methods / Q000592:standards; D011183:Postoperative Complications / Q000517:prevention & control*; D018570:Risk Assessment; D016896:Treatment Outcome