[Preoperative Risk Factors; Hypertension and Arrhythmias]

Generally speaking, hypertension and arrhythmias are risk factors affecting anesthetic management and postoperative prognosis. However, the most recent ACC/AHA clinical guideline does not require the preoperative strict control of arterial pressure for patients with hypertension, since there has been not any definite evidence demonstrating that the preoperative control improves postoperative cardiovascular prognosis. On the other hand, the guideline recommends that preoperative management of patients with arrhythmias should be done according to the guideline for each arrhythmia. However, the guideline does not definitely mention the type of arrhythmias in which we should give priority to treatment of the arrhythmias over anesthesia for an elective operation. Presumably, the paucity of clinical studies to address this issue limits the definite recommendations. In patients with serious arrhythmias, such as ventricular tachycardia and atrial fibrillation with thrombus in the left atrium, preoperative clinical conference including anesthesiologist surgeons and cardiologists should be performed to decide the treatment plan for the patient Antihypertensive and antiarrhythmic drugs are frequently given in patients with hypertension or arrhythmias. These medicines as a general rule should be given until the morning of the operation day, although we do not have definite clinical evidence to support the advantage of the continuing.