[The anesthesiologic risk patient. Preoperative evaluation, intraoperative management and postoperative monitoring]

A high-risk patient is a challenge to the anaesthesiologist. If surgical intervention is indicated the perioperative anaesthesiological management has to be carefully adapted to the requirements of the patient. If the patient is classified a high-risk at the preoperative anaesthesiological assessment, the therapeutic management has to aim at optimizing the patient's preoperative physical status. Intraoperatively, the minimal monitoring standards have to be extended by addition of specific non-invasive or invasive monitoring techniques to observe the intraoperative cardiovascular or pulmonary function according to the patient's preoperative disease. There are no recommendations about the choice of the anaesthesia techniques; the decision for general or regional anaesthesia depends on the site of operation and is guided by the individual experience of the anaesthesiologist. During the postoperative period each high-risk patient has to be observed in the intensive care unit to continue intraoperative monitoring and therapy. Patients at risk of postoperative myocardial ischaemia or infarction should be closely monitored for 3-5 days postoperatively. The perioperative risk of morbidity and mortality associated with elective surgical procedures has to be evaluated for each patient and the risk-benefit analysis discussed in a interdisciplinary dialogue involving the surgeon, the patient and the patient's family.