The peri-operative patient with cardiac disease

As a physician (and anaesthetist), one of your more common referrals from your surgical colleagues will be optimising them in the peri-operative period, in regards to one of their many chronic conditions, most often cardiac, respiratory, or renal. This article in the AFP nicely looks at the former group and gives some evidence based advice.

This came to the fore after studies a few years ago showed that starting beta blockers in the immedate peri-operative period was associated with increasd mortality, but starting them weeks prior improved the situation greatly. From there however, it’s about breaking it down:

  • anti-platelet therapy – think about who is high risk, and continue aspirin (after argument with surgeons) where you can. Be especially careful in those with drug eluting stents in the first 12 months who will be on dual therapy. Those on it for primary prevention don’t have as strong an indication as those for secondary prevention, where aspirin should be continued.
  • lipid/endothelial – the famed statin has a variety of beneficial effects, particularly when it comes to vascular surgery
  • blood pressure control – goes without saying

If you want to delve further – and you should, since perioperative medicine is a hot topic – read the article here.

And don’t forget to tell your patients to stop smoking (even 3-4 weeks before surgery helps), and watch those ventilator settings.

 

source | AFP

image | Army Medicine

 

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