Preoperative Cardiac Evaluation for Elective Noncardiac Surgery

摘要: We reviewed the approach to preoperative cardiac risk assessment, incorporating new information regarding pathophysiologic features of perioperative myocardial ischemia and recent clinical trials. Relevant articles were identified from a MEDLINE search, followed by bibliography review identified. The multifactorial indexes are valuable in stratifying risks among unselected patients undergoing noncardiac surgery, but they underestimate selected groups, particularly with peripheral vascular disease. evaluation coronary artery disease reduction strategies for high-risk considered. There no prospective randomized data comparing revascularization intensive medical therapy decisions must be individualized. Risks particular congestive heart failure valvular also reviewed. Patients can undergo surgery safely, if their is well-compensated. aortic stenosis have high risks, management include valve replacement, valvuloplasty, aggressive treatment. These modalities not been compared prospectively, Preoperative arrhythmias important factors, although appear confer only when due underlying A thorough, targeted history physical examination supplemented judicious laboratory studies usually sufficient assess patient's upcoming surgery. should identify factors that predict complications, special attention given those modified before New developments medicine will likely lead postoperative interventions reduce silent complications.