Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery

Abstract

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Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study

“…We did not measure oxygen demand or the tissue partial pressure of oxygen but our algorithm was aimed at optimizing intravascular volume and CI resulting in the same effect of improved tissue perfusion and oxygenation. A currently published meta-analysis could not identify evidence for an increased risk of treatment-related cardiac complications following the use of inotropes due to GDT [36], but it is important to note that, if the indication for inotropes is increased on the basis of these findings, special attention will be necessary in high-risk cardiac patients, where current clinical guidelines recommend perioperative ß-blockade as cardioprotection [37]. Although we did not recognize any signs of postoperative myocardial infarction in our patients, further research needs to be directed at this growing subgroup of surgical patients.…”

Daily Administration of Atorvastatin and Simvastatin for One Week Improves Cardiac Function in Type 1 Diabetic Rats

“…In line with this evidence, the 2009 European Society of Cardiology Guidelines recommended the use of statins in high-risk surgery patients between 30 days and 1 week prior to surgery [38]. Diabetes complications, however, include not only macrovascular complications, but also microvascular (e.g.…”

β-blockers and risk of all-cause mortality in non-cardiac surgery

“…Moreover, according to recent guidelines [Fleischmann et al 2009;Poldermans et al 2009], treatment with b-blockers should be initiated between 30 days and 1 week before surgery with a target resting heart rate 6070 beats/ min and systolic blood pressure >100 mmHg. Postoperative tachycardia requires, first of all, diagnosis and management of potential underlying causes (i.e., hypovolemia, hemorrhages, infections) before considering up-titration of b-blocker dosage.…”