What is included in preoperative and intraoperative cardiac management?

Updated: Feb 04, 2019
  • Author: Davinder Jassal, MD; Chief Editor: William A Schwer, MD  more...
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Answer

Answer

The stress of surgery results in the release of catecholamines. Increasing the rate-pressure product may predispose the patient to a cardiac event. In 1996, Mangano et al evaluated the role of atenolol perioperatively in reducing long-term cardiac morbidity and mortality. [9] Patients received a beta-blocker if they had known coronary artery disease or met 2 of the following criteria: older than 65 years, hypertension, total cholesterol level higher than 6.2 mmol/L, smoking history, or diabetes mellitus.

Atenolol produced a 15% absolute risk reduction in the end points of MI, unstable angina, CHF requiring hospitalization, or death at 6 months and reduced mortality at 6 months and 2 years in noncardiac surgery.

Similarly, another randomized controlled trial evaluating the cardioprotective effects of bisoprolol in high-risk patients undergoing vascular surgery was performed. The study was stopped early because of the dramatic results. In 1999, Poldermans et al screened 1351 patients awaiting vascular surgery and included those who had one or more cardiac risk factors and positive results on a dobutamine echocardiography study. [10] The 112 patients remaining were randomized to receive either standard care or standard care plus bisoprolol. Bisoprolol, at a dose of 10 mg PO qd given 1 week preoperatively and continued for 1 month postoperatively, reduced the incidence of perioperative death from cardiac causes and nonfatal MI. Consequently, when possible, beta-blockers should be started 1 week before elective surgery, with the dose titrated to a resting heart rate of 50-60. As for the use of nitrates, digitalis, and calciumblockers, no studies have evaluated their use in the perioperative state.


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