Anaesthesia for patients with cardiac disease undergoing non-cardiac surgery

One of the biggest challenges for anaesthetists today is the safe conduct of anaesthesia for patients who may be elderly, have pre-existing cardiac disease and scheduled to undergo non-cardiac surgery. Within the financial constraints of today's health services, the appropriate investigations need to be decided for these patients in order to inform the anaesthetist, surgeon and the patient of the risk of surgery. The preoperative assessment will help with the formation of a preoperative management plan, including preoperative optimization, in order to minimize the risk of an adverse outcome. The most recent guidelines for preoperative cardiovascular evaluation for non-cardiac surgery are discussed in detail, including assessment of risk factors and cardiac investigations. Current thinking in preoperative therapy, intraoperative management and postoperative management is discussed. Although most patients with cardiac disease have ischaemic heart disease, other specific cardiac conditions and the principles of their management are discussed briefly. © 2006 Elsevier Ltd. All rights reserved.