[Perioperative risk reduction in vascular surgery via cardio-protective medication].
Cardiovascular complications are the leading cause of death after noncardiac surgery. Preoperative identification of patients with underlying coronary artery disease is important, and appropriate treatment strategies should be implemented in these patients in order to reduce the risk of perioperative complications. Based on recent findings, preoperative risk stratification models have been developed to identify high-, intermediate- or low-risk patients; the concentration of natriuretic peptides is a promising new preoperative risk marker. beta-blockers considerably reduce this risk. In clinical practice, important factors are adequate beta-blocker dosage, tight perioperative heart-rate control and continuation of beta-blockers after discharge. Recently, statins have emerged as drugs with perioperative cardioprotective properties, but more randomized clinical trials are needed before routine administration ofstatins can be recommended. Perioperative medical management should focus on improvements not only in the short-term but also in the long-term.
Feringa
H H H
HH
Afd. Cardiologie, Erasmus MC-Centrum, Dr.Molewaterplein 40, 3015 GD Rotterdam.
Bax
J J
JJ
Poldermans
D
D
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D010347:Patient Care Planning; D019990:Perioperative Care / Q000379:methods / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*
D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors