PERIOPERATIVE ANESTHETIC MANAGEMENT FOR PATIENTS WITH MYOCARDIAL ISCHEMIA IN NON CARDIAC SURGERY

Abstract

Ischemic heart disease, which reflects the presence of atherosclerosis in coronary arteries is present in an estimated 30% of patients who undergo surgery annually in the Untied States. Angina pectoris, acute myocardial infarction, and sudden death are often the first manifestations of ischemic heart disease. Cardiac dysrhythmias are probably the major cause of sudden death in patients with ischemic heart disease. The goal of preoperative cardiac assessment is to identify patients at increased risk for adverse perioperative cardiac events including myocardial infarction. In this regard, perioperative MI can be precipitated by increase in myocardial oxygen consumption, alteration in coagulation that precipitate thrombosis, intraoperative and postoperative stress responses are important determinants of perioperative cardiac morbidity. No single test can assess all these factores. Specialized perioperative testing includes electrocardiography, echocardiography, radionuclide ventriculorgapy and thallium scintography. These non invasive testing should be reserved for patients in whom the results are critical for guiding therapy. In patients with coronary artery disease who show strongly positive results on non invasive test, a possible recommendation is coronary revascularization prior to surgery. Intraoperative anesthetic technique utilized should permit modulation to sympathetic nervous system responses and prompt control of hernodynamic variable persistent tachycardia, systolic hypertension,