[Prevention of perioperative cardiac complications in non-cardiac surgery: an evidence-based guideline].
Approximately 2.5% of the patients undergoing non-cardiac surgery suffer from perioperative cardiac complications. These are associated with a mortality of 20.60%, a longer stay in hospital and higher costs. The risk factors for perioperative cardiac complications are: high-risk surgery, ischaemic heart disease, a history of congestive heart failure, cerebrovascular disease, diabetes, and renal failure. Recently, the scope of medical management has shifted from assessing and treating underlying culprit coronary lesions toward coronary plaque stabilisation and prevention of myocardial oxygen supply demand mismatch. Currently, the prevention of cardiac problems consists of identification of the patients at risk, optimisation of the preoperatieve condition by modification of underlying risk factors, optimisation of the perioperative medication with adrenergic beta-antagonists, statins, and acetylsalicylic acid, adequate perioperative monitoring and measures to prevent myocardial ischaemia. These include adequate sedation and analgesia, adequate oxygenation, oxygen transport, and ventilation, and if necessary additional cardiac medication.
Damen
J
J
Universitair Medisch Centrum St Radboud, afd. Anesthesiologie, Huispost 550, Postbus 9101, 6500 HB Nijmegen. j.damen@anes.umcn.nl
Hagemeijer
J W
JW
van den Broek
L
L
Poldermans
D
D
D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D007902:Length of Stay; D010347:Patient Care Planning; D019990:Perioperative Care / Q000379:methods / Q000592:standards*; D017410:Practice Guidelines as Topic; D011300:Preoperative Care; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D013514:Surgical Procedures, Operative / Q000009:adverse effects*
D002316:Cardiotonic Agents