Perioperative pharmacological therapy: - It can be beneficial to use volatile anesthetic agents during noncardiac surgery for the maintenance of general anesthesia in hemodynamically stable patients at risk for myocardial ischemia (1).
- Beta blockers should be continued in patients undergoing surgery who are receiving beta blockers to treat angina, symptomatic arrhythmias, hypertension, or other ACC/AHA Class I guideline indications (target frequency: <65 beats per minute) (1,2). The initiation of beta-blocker therapy for prevention of perioperative cardiac complications in noncardiac surgery is no longer a performance measure (2).
- For patients currently talking statins and scheduled for noncardiac surgery, statins should be continued (1).
- Several authors have suggested withholding angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists the morning of surgery. Consideration should be given to restarting angiotensin-converting enzyme inhibitors in the postoperative period only after the patient is euvolemic, to decrease the risk of perioperative renal dysfunction (1).
References: - ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. Anesthesia & Analgesia. 2008;106:685-712: full text | pdf.
- Todd Stern et al. Perioperative beta-blocker therapy. JAMA. 2015;313(24):2486-2487: full text | pdf.
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