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Preoperative evaluation of the cardiac patient for noncardiac surgery

Évaluation pré-opératoire du patient cardiaque en vue d’une chirurgie non-cardiaque


En résumé, la cuieillette d’une histoire clinique complète est une partie critique dans le diagnostic et la stratification du risque des patients avec maladie cardiaque qui vont subir une chirurgie non-cardiaque. Plusieurs des facteurs associés à la morbidité cardiaque péri-opératoire sont amenables à la thérapie, et un traitement agressif et précoce semble avoir des effets bénéfiques sur la morbidité et la mortalité41.


  1. 1

    Mangano DT. Perioperative cardiac morbidity. Anesthesiology 1990; 72: 153–84.

  2. 2

    Ibrahim M, Chobanian AV, Horan M, Roccella EJ. Hypertension prevalance and the status of awareness, treatment and control in the United States. Hypertension 1985; 7: 457–68.

  3. 3

    Dustan HP, Chobanian AV, Falkner et al. The 1984 report of the joint national committee on detection, evaluation, and treatment of high blood pressure. Arch Int Med 1984; 144: 1045–57.

  4. 4

    Kaplan NM. Systemic hypertension: mechanisms and diagnosis.In: Braunwald E. (Ed.). Heart Disease. Philadelphia: WB Saunders, 1988; 819–61.

  5. 5

    Bedford RF, Feinstein B. Hospital admission blood pressure, a predictor for hypertension following endotracheal intubation. Anesth Analg 1980; 59: 357–70.

  6. 6

    Asiddao CB, Donegan JH, Whitsell RC, Kalbfleish JH. Factors associated with perioperative complications during carotid endarterectomy. Anesth Analg 1982; 61: 631–7.

  7. 7

    Hartford M, Wendelhag I, Berglund G, Wallentin I, Ljungman S. Cardiovascular and renal effects of longterm antihypertensive treatment. JAMA 1988; 259: 2553–7.

  8. 8

    Prys-Roberts C, Meloche R, Foex P. Studies of anaesthesia in relation to hypertension: I. cardiovascular responses to treated and untreated patients. Br J Anacsth 1971; 43: 122–37.

  9. 9

    Stone JG, Foex P, Scar JW, Johnson LL, Khambatta HJ, Triner L. Myocardial ischemia in untreated hypertensive patients: effect of a single small dose of a betaadrenergic blocking agent. Anesthesiology 1988; 68: 495–500.

  10. 10

    Marantz PR, Tobin JN, Wassertheil-Smollers S et al. The relationship between left ventricular systolic function and congestive heart failure diagnosed by clinical criteria. Circulation 1988; 77: 607–12.

  11. 11

    Bigger JrJT. Why patients with congestive heart failure die: arrhythmias and sudden death. Circulation 1987: 75 (suppl IV): 28–35.

  12. 12

    Packer M, Lee WH, Kessler PD, Gottlieb SS, Bernstein JL, Kukin ML. Role of ncurohormonal mechanism in determining survival in patients with severe congestive heart failure. Circulation 1987; 75 (suppl IV): 80–92.

  13. 13

    Massie BM, Conway M. Survival of patients with congenital heart failure: past, present, and future prospects. Circulation 1987; 75 (suppl IV): 11–9.

  14. 14

    Hertzer NR, Bevan EG, Young JR et al. Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. Ann Surg 1984; 199: 223–33.

  15. 15

    Brown OW, Hollier LH, Pairolero PC, Kzmier FJ, McCready RA. Abdominal aortic aneurysm and coronary artery disease. Arch Surg 1981; 116: 1484–8.

  16. 16

    Perry MO, Calcagno D. Abdominal aortic aneurysm surgery: the basic evaluation of cardiac risk. Ann Surg 1988; 208: 738–42.

  17. 17

    Shub C. Stable angina pectoris: 1. Clinical patterns. Mayo Clin Proc 1990; 64: 233–42.

  18. 18

    Shub C. Stable angina pectoris: 2. Cardiac evaluation and diagnostic testing. Mayo Clin Proc 1990; 65: 243–55.

  19. 19

    Gerson MC, McHenry PL. Resting U wave inversion as a marker of stenosis of the left anterior descending coronary artery. Am J Med 1980; 69: 545–50.

  20. 20

    Gibson RS, Belter CA. Should exercise elcctrocardiography testing be replaced by radioisotope methods?In: Rahimtoola SH (Ed.). Controversies in Coronary Artery Disease. Philadelphia, FA Davis, 1983: 1–31.

  21. 21

    Shulman P. Bayes’ theorem — a review. Cardiol Clin 1984; 2: 319–28.

  22. 22

    Younis LT, Chaitman BR. Update on intravenous dipyridamole cardiac imaging in the assessment of ischemic heart disease. Clin Cardiol 1990; 13: 3–10.

  23. 23

    McPhail NV, Ruddy TD, Calvin JE, Davies RA, Barber GG. A comparison of dipyridamole-thallium imaging and exercise testing in prediction of postoperative cardiac complications in patients requiring arterial reconstruction. J Vasc Surg 1989; 10: 51–6.

  24. 24

    Marwick TH, Underwood DA. Dipyridamole thallium imaging may not be a reliable screening test for coronary artery disease in patients undergoing vascular surgery. Clin Cardiol 1990; 13: 14–8.

  25. 25

    Dilsizian V, Rocco TP, Freedman NM, Leon MB, Bonow R. Enhanced detection of ischemic but viable myocardium by the reinjection of thallium after stress redistribution imaging. N Engl J Med 1990; 323: 141–6.

  26. 26

    Levinson JR, Boucher CA, Colley CM, Guiney TE, Strauss HW, Eagle KA. Usefulness of semiquantitative analysis of dipyridamole thallium-201 redistribution for improving risk stratifications before vascular surgery. Am J Cardiol 1990; 66: 506–10.

  27. 27

    Parmely WW. Prevalence and clinical significance of silent myocardial ischemia. Circulation 1989: 80 (suppl IV): 68–73.

  28. 28

    Knight AA, Hollenberg M, London MJ et al. Perioperative myocardial ischemia: importance of preoperative ischemia pattern. Anesthesiology 1988; 68: 681–8.

  29. 29

    Epstein SE, Quyymi AA, Bonow RO. Current conceptsmyocardial ischemia — silent or symptomatic? N Engl J Med 1988; 318: 1038–43.

  30. 30

    Knoebel SE, Crawford MH, Donn MI et al. Guidelines for ambulatory clectrocardiography. Circulation 1989; 79: 206–15.

  31. 31

    Cahalan MK, Litt L, Botvinick EH, Schiller NB. Advances in noninvasive cardiovascular imaging: implications for the anesthesiologist. Anesthesiology 1987: 66: 356–72.

  32. 32

    Eagle KA, Boucher CA. Cardiac risk of noncardiac surgery. N Engl J Med 1989; 321: 1330–2.

  33. 33

    Goldman L, Caldera DL, Nussbaum SR et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977; 297: 845–50.

  34. 34

    Raby KE, Goldman L, Creager MA et al. Correlation between perioperative ischemia and major cardiac events after peripheral vascular surgery. N Engl J Med 1989; 321: 1296–300.

  35. 35

    Geft IL, Fishbein MC, Ninomiya K et al. Intermittent brief periods of ischemia have a cumulative effect and may cause myocardial necrosis. Circulation 1982; 66: 1150–3.

  36. 36

    Pasternack PF, Grossi EA, Baumann FG et al. The value of silent ischemia monitoring in the prediction of perioperative myocardial infarction in patients undergoing peripheral vascular surgery. J Vasc Surg 1989; 10: 617–25.

  37. 37

    Epstein SE. Implications of probability analysis on the strategy used for non-invasive detection of coronary artery disease. Am J Card 1980; 46: 491–9.

  38. 38

    Eagle KA, Coley CM, Newell JB et al. Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery. Ann Int Med 1989; 110: 859–66.

  39. 39

    Charison ME, MacKenzie CR, Ales KL, Gold JP, Fairclough JrG, Shires CT. Surveillance for postoperative myocardial infarction after non-cardiac operations. Surg Gynecol Obstet 1988; 167: 407–14.

  40. 40

    McCloskey G, Hines R, Barash P. Is ICU admission necessary for postoperative ROMI workup? (Abstract). Anesthesiology 1989; 71: A954.

  41. 41

    Rao TK, Jacobs KH, El-Etr AA. Reinfarction following anesthesia in patients with myocardial infarction. Anesthesiology 1983; 59: 499–505.

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Correspondence to Paul G. Barash.

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Barash, P.G. Preoperative evaluation of the cardiac patient for noncardiac surgery. Can J Anaesth 38, R134–R144 (1991).

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  • Thallium
  • Dipyridamole
  • Myocardial Infraction
  • Congestive Heart Failure
  • Postoperative Cardiac Event