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 might be elderly, have pre-existing cardiac disease and are scheduled to undergo non-cardiac surgery. Within the financial constraints of today's health services, the appropriate investigations need to be decided and performed for these patients in order to inform the anaesthetist, surgeon and the patient of the risk of surgery. These should be undertaken only if they will influence management of the patient. The preoperative assessment will help with the formation of a perioperative management plan, including preoperative optimisation and postoperative care, 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.