[Cardiac risk patients in anesthesia]

Cardiac complications are the major cause of morbidity and mortality in patients undergoing noncardiac operations. The perioperative risk of adverse cardiac events is particularly high in patients with significant coronary artery disease, heart failure or critical aortic stenosis. Prolonged intraperitoneal and intrathoracic operations, major vascular surgery, emergency procedures, and intraoperative hypotension and tachycardia promote and increase incidence and severity of cardiac complications. Recent experience has shown, however, that elective noncardiac operations can be performed with justifiable risk even in patients with endstage cardiac disease awaiting heart transplantation. Surgery, if indicated, can thus nowadays hardly be denied even in the presence of high cardiac risk. Successful anesthetic management requires detailed information about the cause and severity of the underlying disease, thorough understanding of its specific hemodynamic particularities, indepth knowledge about hemodynamic effects and interactions of anesthetic drugs, and experience with extended hemodynamic monitoring. Anesthetic choice by itself appears to be of minor significance. Cardiac surgery prior to major elective noncardiac procedures is advocated in patients with significant coronary artery disease or severe valve lesions. The incidence of life-threatening cardiac complications is particularly high in the postoperative period; prolonged hemodynamic monitoring in an intensive care unit is therefore mandatory.