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6 - Cardiovascular disease

Published online by Cambridge University Press:  12 January 2010

By
Howard Weitz
Edited by
Michael F. Lubin ,
Robert B. Smith ,
Thomas F. Dodson ,
Nathan O. Spell  and
H. Kenneth Walker
Howard Weitz
Affiliation:
Thomas Jefferson University Hospital, Philadelphia, PA
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Robert B. Smith
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Nathan O. Spell
Affiliation:
Emory University, Atlanta
H. Kenneth Walker
Affiliation:
Emory University, Atlanta
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Summary

General overview

A team approach to patients with cardiovascular disease who undergo non-cardiac surgery is the ideal way to expedite perioperative care. It is essential to assess patients' risk of cardiac complications and to identify those risk factors that may be reversed or ameliorated if time allows before surgery. The most likely cardiovascular problems that patients may encounter in the perioperative period should also be anticipated and an approach to these problems planned in advance. For the patient who undergoes surgery on an emergency basis, preoperative evaluation may be limited to those components that are critical and essential for the surgical procedure. In these circumstances the consultant may well perform a more detailed evaluation in the postoperative period. For many patients the preoperative evaluation is their only opportunity for medical assessment. The consultant should bear this in mind and consider the preoperative evaluation visit as an opportunity for assessment of general cardiovascular risk and development of a plan for cardiac risk reduction.

The physicians who are responsible for preoperative cardiac risk assessment and perioperative care vary according to locale. In many regions, family physicians, general internists, or cardiologists perform these duties. In other areas, these tasks are performed by surgeons or anesthesiologists. The selection of anesthetic agents as well as their means of administration is typically the domain of anesthesiologists; however, it is essential that surgeons and medical consultants understand the basic cardiovascular and hemodynamic effects of anesthesia.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 63 - 101
Publisher: Cambridge University Press
Print publication year: 2006

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