[Preoperative preparation of patients with cardiovascular disease for noncardiac surgery].
Preoperative preparation of patients with cardiovascular disease is best initiated by the general practitioner. Updated Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery have been published by the American Heart Association und American College of Cardiology (2007). Individual cardiac evaluation must take into account active cardiac conditions, functional capacity, additional clinical risk factors and surgical risk. Stable, asymptomatic patients with normal functional capacity can proceed to elective anesthesia and surgery without further cardiac evaluation. Active cardiac conditions require evaluation and treatment by a cardiology service prior to elective surgery. In stable patients with poor (<4 metabolic equivalents, MET) or unknown functional capacity and clinical risk factors, who are scheduled for intermediate- or high-risk surgery, further cardiac evaluation and preparation is to be considered. Established indicated beta blocker and statin medication is to be continued; timely institution of beta blocker medication (target heart rate, <65 bpm) may be required depending on the risk of surgery, the presence of coronary heart disease, and the number of clinical risk factors present. Following percutaneous coronary intervention, specific waiting periods are required prior to elective surgery. In patients on antiplatelet therapy, the risk of stopping it should be weighed against the benefit of reduction in bleeding complications from the planned surgery.
Doser
Martin
M
Universitätsklinik für Anästhesiologie und Schmerztherapie, Universitätsspital Bern, Bern.
Eberle
Balthasar
B
D000758:Anesthesia / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000145:classification / Q000150:complications / Q000503:physiopathology*; D015897:Comorbidity; D003299:Cooperative Behavior; D003663:Decision Trees; D006305:Health Status Indicators; D006801:Humans; D033183:Interdisciplinary Communication; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D011300:Preoperative Care; D011379:Prognosis; D013557:Switzerland