Assessing and minimization of perioperative risk in cardiologic patient in non-cardiac surgery
Keywords:non-cardiac surgery, perioperative risk, perioperative drug therapy, review
AbstractThe article describes perioperative evaluation of patients in whom cardiac disease can cause complications during non-cardiac surgery. The paper is based on the data from last guidelines on cardiovascular assessment and management during non-cardiac surgery which were published by the European Society of Cardiology and the European Society of Anesthesiology (2014), American College of Cardiology and American Heart Association (2014), and the Canadian Cardiovascular Society (2017). Heart complications during non-cardiac surgery depend both on patient-related and surgical risk factors. The patient should be evaluated step-by-step. It should be taken into the account the urgency and type of surgery; the risk of the surgical procedure (Lee score, NSQIP MICA model), all active or unstable cardiac conditions and cardiac risk factors should be evaluated, as well as the functional capacity of a patient to be determined. In certain circumstances, the multidisciplinary team should be involved in individualized perioperative management of a patient. Non-invasive stress-tests should be performed in some cases to stratify a risk for a patient. Optimal medical treatment and ever coronary revascularization should be considered to stabilize a patient and predict adverse outcome. The article highlights risk reduction strategy by perioperative management with cardiologic medications. The authors emphasized advantages of continuation of beta-blockers usage at the day of surgery. The paper describes the management of patients taking chronic anti-platelet agents and anticoagulants, including bridge therapy with heparins in persons taking oral anticoagulants. Few clinical cases of perioperative evaluation are presented to highlight the practical implementation of step-by-step perioperative evaluation of a patient.
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