Document Detail


Pre-operative risk assessment and risk reduction before surgery.
MedLine Citation:
PMID:  18482658     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Perioperative myocardial infarctions are the predominant cause of morbidity and mortality in patients undergoing noncardiac surgery. The pathophysiology of perioperative myocardial infarction is complex. Prolonged myocardial ischemia due to the stress of surgery in the presence of a hemodynamically significant coronary lesion, leading to subendocardial ischemia, and acute coronary artery occlusion after plaque rupture and thrombus formation contribute equally to these devastating events. Perioperative management aims at optimizing the patient's condition by identification and modification of underlying cardiac risk factors and diseases. During recent decades there has been a shift from the assessment and treatment of the underlying culprit coronary lesion toward a systemic medical therapy aiming at prevention of myocardial oxygen supply demand mismatch and coronary plaque stabilization. Beta-blockers, statins, and aspirin are widely used in this setting. The role of prophylactic coronary revascularization has been restricted to the same indications as the nonoperative setting. Therefore pre-operative cardiac testing is recommended only if test results will change perioperative management. In addition to the limited perioperative period, physicians should benefit from this opportunity to initiate lifestyle changes and medical therapy to lessen the impact of cardiac risk factors, as patients should live long enough after the operation to enjoy the benefits of surgery.
Authors:
Don Poldermans; Sanne E Hoeks; Harm H Feringa
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Intramural; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  51     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-16     Completed Date:  2008-06-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1913-24     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands. d.poldermans@erasmusmc.nl
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MeSH Terms
Descriptor/Qualifier:
Humans
Myocardial Infarction / etiology*,  physiopathology*
Patient Care Planning
Postoperative Complications
Preoperative Care
Risk Assessment
Risk Reduction Behavior
Surgical Procedures, Operative / adverse effects*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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