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Published on: March 27, 2018
[Preoperative preparation of patients with cardiovascular disease for noncardiac surgery]
Martin Doser1, Balthasar Eberle
1Universitätsklinik für Anästhesiologie und Schmerztherapie, Universitätsspital Bern, Bern.
Insights
General practitioners should guide preoperative cardiovascular disease preparation. Guidelines recommend individualized cardiac evaluation based on patient condition, functional capacity, and surgical risk for optimal perioperative care.
Area of Science:
- Cardiology
- Anesthesiology
- General Practice
Context:
- Preoperative preparation for patients with cardiovascular disease is crucial.
- Updated guidelines from the American Heart Association and American College of Cardiology (2007) provide a framework for perioperative cardiovascular evaluation and care for noncardiac surgery.
- General practitioners play a key role in initiating this preparation.
Purpose:
- To outline the essential considerations for preoperative cardiovascular evaluation and management in patients undergoing noncardiac surgery.
- To guide clinicians in risk stratification and decision-making for elective procedures.
- To emphasize the importance of individualized patient assessment.
Summary:
- Individual cardiac evaluation should consider active cardiac conditions, functional capacity (e.g., metabolic equivalents), clinical risk factors, and surgical risk.
- Stable, asymptomatic patients with normal functional capacity may proceed without further cardiac evaluation.
- Active cardiac conditions necessitate cardiology consultation and treatment before elective surgery.
- For stable patients with poor or unknown functional capacity and risk factors undergoing intermediate- or high-risk surgery, further evaluation and preparation are recommended.
- Continuation of established beta-blocker and statin therapy is advised.
- Timely initiation of beta-blocker medication may be necessary to achieve a target heart rate (<65 bpm), depending on surgical risk, coronary heart disease, and clinical risk factors.
- Specific waiting periods are required after percutaneous coronary intervention before elective surgery.
- The risks of discontinuing antiplatelet therapy must be weighed against the benefits of reduced surgical bleeding complications.
Impact:
- Facilitates informed decision-making regarding the safety of elective surgery for patients with cardiovascular disease.
- Promotes optimized perioperative management, potentially reducing cardiovascular complications.
- Supports the role of general practitioners and cardiologists in collaborative patient care.
- Highlights the need for careful consideration of medication management, including beta-blockers and antiplatelet agents.
Abstract:
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.
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