29 Sep 07
ACC/AHA 2007 Guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery
By Lee A. Fleisher, Joshua A. Beckman, Kenneth A. Brown, Hugh Calkins, Elliott Chaikof, Kirsten E. Fleischmann et al.
Circulation 2007;116:e418-e499
Conclusions
Successful perioperative evaluation and management of highrisk cardiac patients undergoing noncardiac surgery requires careful teamwork and communication between surgeon, anesthesiologist, the patient’s primary caregiver, and the consultant. In general, indications for further cardiac testing and treatments are the same as in the nonoperative setting, but their timing is dependent on several factors, including the urgency of noncardiac surgery, patient-specific risk factors, and surgery-specific considerations. The use of both noninvasive and invasive preoperative testing should be limited to those circumstances in which the results of such tests will clearly affect patient management. Finally, for many patients, noncardiac surgery represents their first opportunity to receive an appropriate assessment of both short- and long-term cardiac risk. Thus, the consultant best serves the patient by making recommendations aimed at lowering the immediate perioperative cardiac risk, as well as assessing the need for subsequent postoperative risk stratification and interventions directed at modifying coronary risk factors. Future research should be directed at determining the value of routine prophylactic medical therapy versus more extensive diagnostic testing and interventions.