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Pre-operative cardiac optimisation: a directed review.

L K K Lee1, P N W Tsai2, K Y Ip3

  • 1Department of Anaesthesia, Pamela Youde Nethersole Eastern Hospital, Hong Kong Special Administrative Region, Hong Kong, China.

Anaesthesia
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Summary

Anesthesiologists can improve patient safety during major surgery by optimizing cardiac conditions. This involves proactive risk assessment and management of hypertension, heart failure, and device implantation for better peri-operative outcomes.

Keywords:
cardiac morbidity: pre-operative factorsheart failurehypertensionvalvular disease

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Area of Science:

  • Anesthesiology
  • Cardiology
  • Peri-operative Medicine

Background:

  • Cardiac events are a major cause of death and illness during surgery.
  • High-risk patients undergoing surgery face significant, yet potentially preventable, cardiac risks.

Purpose of the Study:

  • To highlight the critical role of anesthesiologists in peri-operative cardiac risk assessment and management.
  • To emphasize evidence-based practices for optimizing cardiac conditions in surgical patients.

Main Methods:

  • Review of current evidence-based practices and international guidelines for peri-operative cardiac care.
  • Discussion on managing hypertension, chronic heart failure, valvular heart disease, and cardiac implantable electronic devices.
  • Exploration of pre-operative cardiac risk assessment and biomarkers.

Main Results:

  • Anesthetist-led services, including echocardiography and device management, are increasingly needed.
  • Proactive pre-operative risk stratification and timely multidisciplinary referrals improve patient safety.
  • Personalized cardiac optimization leads to safer surgical journeys for at-risk patients.

Conclusions:

  • Anesthesiologists play a vital role in reducing peri-operative cardiac morbidity and mortality.
  • Adherence to guidelines and a personalized approach enhance patient safety in major surgery.
  • Early identification and management of cardiac risks are crucial for surgical success.