Preoperative cardiac preparation

Preoperative preparation of the cardiac patient is based on matching the ca rdiac reserve to the blood flow demands imposed by surgical stress and the underlying disease state. Evaluation must include functional assessment of any coronary artery disease or other organic cardiac disease that may place myocardial tissue at risk of ischemia as demand for cardiac output increas es. Monitoring should be individualized based on anticipated problems and t he risk assessment of the patient. Preoperative therapy should include mane uvers that reduce congestive heart failure, optimize volume status, and pro vide adequate cardiac output to deliver oxygen sufficient to meet or exceed demand. Underlying electrical and metabolic abnormalities should be correc ted and controlled in the perioperative period. Long-term therapy should be evaluated and modified in the context of the anesthetic and surgical plan. Preventive interventions such as fluid loading and low-dose dopamine shoul d be considered prior to surgery.