Perioperative medical management of ischemic heart disease in patients undergoing noncardiac surgery

Current Opinion in Anaesthesiology
Harm H H FeringaD Poldermans

Abstract

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. 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...Continue Reading

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Citations

Jul 28, 2012·Annals of Vascular Surgery·Katja B C SchampClark J Zeebregts
Mar 9, 2012·Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery·Namir KatkhoudaJoerg Zehetner
Jan 12, 2012·The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland·Russell MullenAlastair M Thompson
Jul 12, 2008·Journal of Clinical Anesthesia·Vesna Miodrag KarapandzicDragan D Babic

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