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Grand Rounds 03/11/15 @ BID-Needham: Dr. Gerald W. Smetana  

Preoperative Cardiac Evaluation
Last Updated: Sep 2, 2016 URL: http://bidmc.libguides.com/Smetana Print Guide RSS Updates
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Speaker: Date: Topic

Gerald W. Smetana, MD

Mar 11, 2015

Preoperative Cardiac Evaluation

      

    Link to the ACS NSQIP Surgical Risk Calculator

    Responsibility for Content

    The PowerPoint presentation, Take-Away points, Links, and Links to Articles Cited were sent by Medical Library Services and the CME Committee.

    Diane E. Young, Information Specialist

    dyoung3@bidmc.harvard.edu

     

        

      Take-Away Points of the Presentation

      1. Patient-related risks include coronary artery disease, congestive heart failure, cerebrovascular disease, renal insufficiency, diabetes mellitus requiring insulin, advanced age (a minor factor after controlling for other comorbidities), and poor functional capacity.

      2. Procedure-related risks include high-risk surgical site (abdominal surgery; chest surgery; major intra-abdominal vascular surgery), emergency surgery, or prolonged surgery.

      3. The AHA/ACC recommends that beta-blockers be continued in patients undergoing surgery if they have been taking the drug chronically. For those with intermediate or high-risk ischemia documented prior to surgery, it is reasonable to begin perioperative blockade. For those with 3 or more risk factors (such as diabetes, heart failure, or coronary artery disease) it is also reasonable to begin beta-blockers prior to surgery. In patients with no risk factors, starting beta-blockers in the perioperative setting provides unknown benefit, especially if a long-term indication for beta-blockade is not noted.

      4. The AHA/ACC recommends that statins should be continued if taken chronically and should be used in all patients undergoing vascular surgery. Statins should be started if there are clinical indications and if the surgery is elevalted risk surgery.

      5. Aspirin provides no benefit and can cause more major bleeding.

      6. Don't revascularize unless you would do so anyway.

          

        Links to Abstracts of Articles Cited (contact Diane Young for full-text articles at dyoung3@bidmc.harvard.edu)

         

        PDF of the PowerPoint Presentation

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          Pre- and Post-Test Questions

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