Perioperative cardiac evaluation, monitoring, and risk reduction strategies in noncardiac surgery patients
PURPOSE OF REVIEW: Cardiac complications after noncardiac surgery cause significant morbidity and mortality. This review will discuss recent developments in risk stratification, monitoring, and risk reduction strategies. RECENT FINDINGS: The addition of biomarkers for ischemia, left ventricular function, and atherosclerosis to classic cardiac risk factors improves the prediction of both short-term and long-term outcome after noncardiac surgery. Intraoperative monitoring, using continuous 12-lead ECG assessment and transesophageal echocardiography, may timely identify treatable myocardial ischemia and arrhythmias. A prudent perioperative beta-blocker and statin regimen can reduce cardiac complications and mortality without increasing the risk of stroke in intermediate to high-risk patients. The use of circulatory assist devices might improve outcomes after major surgery in patients with severely reduced left ventricular function. SUMMARY: Systematic preoperative assessment can identify patients at high risk of cardiac complications and guide the application of appropriate risk reduction strategies.
|Keywords||noncardiac surgery, risk reduction, risk stratification|
|Persistent URL||dx.doi.org/10.1097/MCC.0b013e328348d40f, hdl.handle.net/1765/34162|
Bakker, E.J., Ravensbergen, N.J.C., & Poldermans, D.. (2011). Perioperative cardiac evaluation, monitoring, and risk reduction strategies in noncardiac surgery patients. Current Opinion in Critical Care, 17(5), 409–415. doi:10.1097/MCC.0b013e328348d40f