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[Preoperative evaluation and perioperative management of patients with increased cardiovascular risk]
D Mergner1, P Rosenberger, K Unertl
1Abteilung für Anästhesiologie und Intensivmedizin, Universitätsklinikum, Tübingen.
Insights
Perioperative physicians can reduce cardiovascular complications in high-risk surgical patients using beta-blocker therapy and risk assessment. This review outlines strategies for risk identification and management based on ACC/AHA guidelines.
Area of Science:
- Cardiology
- Anesthesiology
- Geriatric Medicine
Context:
- Aging populations in Western countries necessitate strategies to mitigate risks associated with major surgeries in high-risk individuals.
- Cardiovascular complications pose a significant threat to patients undergoing surgery.
- Identifying and managing perioperative cardiovascular risk is crucial for improving patient outcomes.
Purpose:
- To review current guidelines (ACC/AHA) for identifying patients at increased perioperative cardiovascular risk.
- To discuss evidence-based strategies for reducing perioperative cardiovascular complications.
- To explore the role of medical therapy (e.g., beta-blockers) and interventions in managing surgical patients.
Summary:
- This review outlines a stepwise approach to perioperative risk assessment, considering patient factors, surgical type, and urgency (emergency vs. elective).
- It highlights the established benefit of perioperative beta-blocker therapy in high-risk surgical patients.
- The discussion includes various monitoring techniques and treatment options, emphasizing the need for outcome-focused interventions.
Impact:
- Provides a practical framework for clinicians to manage cardiovascular risk in surgical patients.
- Aims to reduce the incidence of perioperative cardiovascular events and improve surgical outcomes.
- Informs clinical decision-making regarding the use of beta-blockers and other interventions for high-risk surgical populations.
Abstract:
Due to the increasing age in western countries, combined with high rates of major surgical interventions in high-risk patients, perioperative reduction of cardiovascular complications becomes increasingly more important for perioperative physicians. After identifying patients with increased perioperative risk, specific interventions need to be considered to reduce their risk for cardiovascular complications, either by perioperative medical therapy or specific treatment options (e.g. coronary intervention). Several trials have demonstrated an effect of perioperative beta-blocker-therapy in reducing cardiovascular complications among high-risk patients. Additionally, several monitoring techniques are effective in detecting cardiovascular complications. Nevertheless, it remains unclear whether they are associated with a measurable improvement of outcome. Based on the ACC/AHA-guidelines, the present review describes a stepwise approach to surgical patients to identify perioperative risks, based on specific patient related risk factors, the kind of surgery and on the specific setting (emergency versus elective surgery). In addition, strategies to reduce perioperative cardiovascular complications are discussed.
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