Optimal management of patients with ischemic heart disease for noncardiac surgery by complementary anesthesiologist and cardiologist interaction

Abstract

Patients with ischemic heart disease (IHD) constitute a considerable percentage of those undergoing anesthesia and surgery in our population. These patients comprise the spectrum from occult coronary artery disease (CAD) to severe disabling angina pectoris with little cardiac reserve. Often, at the time of noncardiac surgery, a diagnosis of the specific type or exact extent of cardiac disease is not available. Frequently, these patients have many associated disorders including diabetes mellitus, hypertension, cerebrovascular disease, peripheral vascular disease, chronic obstructive pulmonary disease, and/or congestive heart failure (CHF). Much has been reported concerning patients undergoing surgical myocardial revascularization (CABG) and their requirements for careful preoperative evaluation, perioperative monitoring, and postoperative intensive care.’ However, the patient for noncardiac surgery is often older and much sicker with diffuse inoperable CAD. Since the IHD patient undergoing noncardiac surgery does not receive the benefit of CABG, such perioperative care is critical to reduce morbidity and mortality. Unfortunately, there may often be insufficient communication between the patient’s cardiologist and anesthesiologist. A principal objective of this presentation is to provide improved understanding of the anesthesiologist’s role throughout the perioperative period, for the cardiologist to gain enhanced insight into the information needed by the anesthesiologist, and the manner by which the patient is managed. To more clearly demonstrate the interaction between the two specialists, an exemplifying clinical