PREOPERATIVE CARDIAC MANAGEMENT OF PATIENTS UNDERGOING NON CARDIAC-SURGERY

The estimation of an individual patient's ''resistance'' to major surg ery has become an complex matter. Clinical parameters allow risk strat ification in a large number of patients who are about to undergo nonca rdiac surgery. Low risk patients can be ''cleared'' for surgery. Moder ate risk patients should undergo further testing. Exercise testing and pharmacological stress testing with myocardial perfusion imaging can refine risk estimation in these patients. This risk stratification is well backed by scientific data, although most of it is derived from st udies in the same very high risk population, i.e. patients scheduled f or vascular surgery. Less hard evidence exists when it comes to the ma nagement of the high-risk patient. Coronary bypass surgery should prob ably be reserved for those in whom additional indications for this pro cedure exist. The perioperative use of beta-blockers can possibly redu ce operative risk. Data on perioperative monitoring and anesthetic tec hnique are not yet convincing. The relative merits of various perioper ative management strategies will remain uncertain until randomised tri als are performed to evaluate the alternatives systematically.