Coronary heart disease and myocardial infarction -: current status of the perioperative management for noncardiac surgery

The theme of this review article is to describe a variety of perioperative management options for patients with coronary heart disease or myocardial infarction scheduled for noncardiac surgery. The article focuses especially on the guidelines of the American College of Cardiology and the American Heart Association taskforce (1996), The perioperative evaluation and treatment of cardiac risk patients requires careful teamwork between the anaesthesiologist, the surgeon and the internal specialist, The initial history gives the best information about an increased perioperative cardiac risk, According to the history and to the surgery-specific risk, a decision must be made regarding further noninvasive and invasive testing, It is recommended to perform a 12-lead-ECG on routine basis on all patients over 45 years of age. The exercise ECG and the stress-echocardiography are the tests of choice in this context. The perioperative monitoring equipment should be selected with due consideration of the advantages and risks of the different procedures. The EGG-monitoring with ST-segment analysis, pulse oximetry, capnometry and non-invasive blood pressure recording are recommended as basic components. An online-therapy of hypo- or hypertension by an invasive blood pressure measuring is beneficial. Patients undergoing operations,vith high fluid loss should be monitored with a central venous catheter or pulmonary artery catheter, Troponins have been shown to be sensitive biochemical markers for the assessment of myocardial cell injury, Perioperative normothermia (>36 degrees C) reduces the incidence of cardiovascular sensations, A prophylactic perioperative beta-blockade and the application of new alpha(2)-receptor-agonists reduce the incidence of myocardial ischemia and improve the long-term survival rate, The main goal of our teamwork should be to achieve an intensive care management during the first three postoperative days for cardiac risk patients undergoing operations with high or moderate surgery-specific risk.