Cardiovascular perioperative assessment and management

This is an automatically translated article.

The article was consulted with Dr. Tran Hong Nhat - Interventional Cardiologist - Cardiovascular Center - Vinmec Central Park International General Hospital.

1. What is perioperative surgery?

Perioperative period is the period of surgical process from admission, anesthesia, surgery and recovery, which can also be referred to as three phases: preoperative, operative and postoperative.
Pre-surgery: The pre-operative period is used to perform the tests, while trying to limit the patient's pre-operative anxiety. In addition, patients may be asked to follow certain standards to prepare for surgery, such as fasting before surgery. Surgery: The time of surgery begins when the patient is transferred to the operating table and ends with the transfer of the patient to the Anesthesia care department. During this time, the patient is monitored, anesthetized, prepared, and solidified the drain. And then the surgery will be performed. Nursing activities at this stage focus on safety and infection prevention. Additional sterile supplies may be used at this stage if necessary, and applicable segments of the surgical report may be recorded in the patient's electronic health record. Intraoperative radiation therapy and intraoperative blood transfusion delivery may also be performed during this time period. Postoperative (postoperative): The postoperative period begins when the patient is transferred to anesthesia care. This process will end with resolution of the sequelae of surgery. It is quite common for this stage to end the surgeon's care.

2. Cardiovascular surgery

Approximately 5.7 million procedures are performed each year in European patients at high risk of cardiovascular complications. These include at least 167,000 cardiovascular complications from non-heart surgery (about 19,000 of which are life-threatening). Therefore, perioperative cardiovascular assessment is an extremely important process.
Perioperative cardiovascular assessment in patients with noncardiac surgery follows the following steps:
Emergency surgery. Determine whether the cardiovascular status is stable or not Determine the risk of surgery (cardiovascular death within 30 days and myocardial infarction or surgical procedure risk) Functional capacity of the patient having surgery of moderate and high risk In patients with low functional capacity consider the risk of surgery Consider cardiovascular risk factors (ischemic cardiovascular disease may present with angina or history of myocardial infarction, heart failure, stroke, decreased renal function, blood creatinine > 170 micromol/L or 2 mg/dl or clearance < 60 ml/min/1.73 m2, diabetes mellitus require insulin therapy Consider non-invasive testing (stress test and cardiovascular exercise test)

Some perioperative cardiovascular management for patients with noncardiac surgery:
Coronary revascularization before noncardiac surgery Perioperative medical treatment: Perioperative beta-blocker therapy, perioperative statin therapy, primary drug perioperative alpha-2 inhibitors, perioperative enzyme inhibitors, perioperative antiplatelet agents. Adjustment of Anticoagulation Treatment of perioperative conduction disturbances and arrhythmias Perioperative cardiovascular assessment is an important process. This assessment can minimize dangerous complications affecting the patient's health.
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Reference source: wikipedia.org