Abstract
Summary The preoperative management of the patient with coronary artery disease should be focused on optimizing the balance of myocardial oxygen supply to myocardial oxygen demand. This usually involves slowing the heart rate, decreasing systolic arterial pressure while maintaining diastolic arterial pressure, treating any aspect of heart failure, particularly if a dilated ventricle is produced, and allaying the fears and anxieties of the patient, which will only unbalance the myocardial oxygen supply and demand equation. Careful assessment of the patient's history, physical condition, laboratory studies, and the planned surgical procedure permit a certain degree of prediction of risk. This risk prediction also permits planned anesthetic and postanesthetic monitoring to maximize the chances of a smooth perioperative course.
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