Nonkardiyak cerrahide preoperatif kardiyovasküler risk belirleme ve kardiyak hazırlık

Kardiyak hastaların preoperatif değerlendirilmesi anestezistin sıkça karşılaştığı durumlardan biridir. Bu hasta grubunda kardiyovasküler komplikasyonlar nedeni ile perioperatif morbidite ve mortalite riski artmaktadır. Bu nedenle kardiyak hastaların hazırlığında yol gösterici olmak üzere ACC/AHA (Amerikan Kardioloji Okulu/Amerikan Kalp Cemiyeti) bir kılavuz yayınlamıştır. Bu kılavuzda preoperatif kardiyovasküler değerlendirme ve perioperatif yaklaşım ile ilgili öneriler tanımlanmaktadır. Derlememizde 2007 yılında yayınlanmış olan 5 basamaklı algoritmik yaklaşımın vurgulandığı bu kılavuz referans alınarak kardiyak hastalara perioperatif yaklaşım özetlenmiştir. Majör kardiyak komplikasyonları önlemek amacıyla preoperatif risk sınışandırmasına özen gösterilmeli, noninvaziv ek testler perioperatif riski azaltacak tedavilere ışık tutacaksa uygulanmalı ve medikal tedaviler bu doğrultuda planlanmalıdır.

Preoperative cardiac risk assessment and cardiac management preparation in noncardiac surgery

Preoperative assessment of the cardiac patients is one of the big concerns of anesthesiologists. Perioperative morbidity and mortality incidence are increased in these patients due to cardiovascular complications. A guideline has been published by American College of Cardiology/American Heart Association to guide the management of these patients. Recommendations on the preoperative evaluations and perioperative management of these patients are described in this guideline. In this review we summarized the 2007 guideline which emphasis the 5 step algorithmic approach. Attention should be given to preoperative risk stratification and perioperative medical management strategies. Furthermore, noninvasive testing should be reserved for those patients in whom a change in medical therapy will decrease the perioperative risk.

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