Perioperative medical management of ischemic heart disease in patients undergoing noncardiac surgery.
OBJECTIVE
Cardiovascular disease is the leading cause of death after anesthesia and surgery. The preoperative identification of patients with underlying coronary artery disease is important to initiate appropriate treatment strategies in order to reduce the risk of perioperative complications. The current review will discuss new insights in the field of perioperative medicine that can be applied to clinical practice or stimulate further investigation.


RESULTS
Recent findings in the past year have developed preoperative risk stratification in terms of simplicity, safety, accuracy and cost-effectiveness. Natriuretic peptides have been demonstrated to be promising new preoperative risk markers. Although recommended in high-risk patients, noninvasive cardiac stress testing may be safely omitted in patients at intermediate risk. The antiischemic properties of beta-blockers have been well described. In clinical practice, however, adequate beta-blocker dosage, tight perioperative heart rate control and continuation of beta-blockers after surgery may also be important factors. Statins have emerged as promising drugs with perioperative cardioprotective properties. Before recommending routine administration of statin therapy, however, more clinical trials are needed.


CONCLUSIONS
New perceptions in perioperative medical management and novel developments in surgical and anesthesiology techniques continue to improve the cardiovascular outcome of patents undergoing major noncardiac surgery.
Feringa
Harm H H
HH
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Bax
Jeroen J
JJ
Poldermans
Don
D
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000758:Anesthesia; D002316:Cardiotonic Agents / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D017202:Myocardial Ischemia / Q000150:complications* / Q000503:physiopathology*; D019990:Perioperative Care; D018570:Risk Assessment; D013514:Surgical Procedures, Operative
D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors