title: Minimizing cardiac risk in perioperative practice - interdisciplinary pharmacological approaches.
abstract: BACKGROUND
  In an aging population, major surgery is often performed in patients with complex co-morbidities. These patients present new risk constellations so that cardiac and respiratory complications mainly contribute to perioperative morbidity.
  
  
  METHODS
  We composed a narrative review on pharmacological approaches to cardiovascular protection in the perioperative period including effects of central neuraxial blocks and hypothermia on cardiovascular outcome. The single chapters are structured as follows: pathophysiology-early studies-recent evidence-recommendations.
  
  
  RESULTS
  In coping with this challenge, innovative concepts like fast track surgery and pharmacological treatment are being utilized with increasing frequency including perioperative cardioprotection, novel strategies of anticoagulation or antiplatelet therapy, and protocols for postoperative pain therapy.
  
  
  CONCLUSIONS
  All the concepts described require an interdisciplinary approach in collaboration between operative physicians and physicians working in non-surgical disciplines like internal medicine, cardiology, and clinical pharmacology. The perioperative continuation of a pre-existing therapy with beta-blockers and other potentially cardioprotective agents like α(2)-agonists and statines is recommended. In the management of patients presenting for major surgery stratification of the perioperative risk is essential which considers both, invasiveness of the surgical procedure and conditions of the patient. Otherwise, side-effects might outweigh benefits of a potentially effective therapy as recently shown for the perioperative administration of beta-blockers that should be restricted to high-risk patients.
authors.affiliation: Department of Anesthesiology I, Central Hospital of Bolzano, Bolzano, Italy. matthias.bock@asbz.it
authors.forename: Matthias
authors.initials: M
authors.lastname: Bock
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Wiedermann
authors.forename: Johann
authors.initials: J
authors.lastname: Motsch
authors.forename: Gerhard
authors.initials: G
authors.lastname: Fritsch
authors.forename: Markus
authors.initials: M
authors.lastname: Paulmichl
mesh_terms: D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015897:Comorbidity; D003299:Cooperative Behavior; D003328:Coronary Thrombosis / Q000401:mortality / Q000517:prevention & control; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D017052:Hospital Mortality; D006801:Humans; D033183:Interdisciplinary Communication; D007902:Length of Stay; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control*; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D012307:Risk Factors
chemical_list: D002317:Cardiovascular Agents