How to Detect Cardiovascular Dysfunction in the Perioperative Period

  • M. Merli
  • F. Milazzo
  • M. M. Visigalli


The evaluation of preoperative risk and the decisions concerning therapeutics, intraoperative monitoring, choice of anaesthetics, postoperative monitoring and care is a major challenge for the anaesthesiologist. Because of the magnitude of the problems of perioperative cardiovascular (CV) morbidity and mortality, many efforts must be made to assess preoperatively CV dysfunction (1-4) and potential intra and postoperative CV adverse events. Unfortunately, with the advent of “come and go-stay” surgery, limited time is available for assessment; patients are older and sicker, the cost containment may limit the number and type of preoperative tests and, last but not the least, the tests are not clearly conclusive. A general six tiered model for determining the efficacy of a medical technology has been suggested by Fryback (5): technical efficacy, diagnostic accuracy, diagnostic thinking efficacy, therapeutic efficacy, patient outcome efficacy and societal efficacy. With regard to this, the need to evaluate and describe clinical events has often placed physicians in the position of using technologies not completely evaluated. Moreover, the importance and applicability of risk indices, because of changes in strategies, in monitoring and therapies are questionable, poorly helpful in everyday practice and there is no statistical evidence strongly suggesting the use of most monitoring technologies; everyday practice and professional skill, clinical judgement and proved guidelines contribute to appropriate decisions.


Myocardial Ischaemia Wall Motion Abnormality Exercise Stress Testing Noncardiac Surgery Peri Operative Period 
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© Springer-Verlag Italia, Milano 1996

Authors and Affiliations

  • M. Merli
  • F. Milazzo
  • M. M. Visigalli

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