Anesthetic Management of Cardiac Surgery
The preoperative evaluation and anesthetic manage-ment of common cardiovascular diseases are dis-cussed eariler. The same principles apply whether these patients are undergoing cardiac or noncardiac surgery. An important distinction is that patients undergoing cardiac procedures will by definition have advanced disease. Establishing the adequacy of the patient’s preoperative cardiacfunction should be based on exercise (activity) toler-ance, measurements of myocardial contractility such as ejection fraction, the severity and location of coro-nary stenoses, ventricular wall motion abnormalities, cardiac end-diastolic pressures, cardiac output, and valvular areas and gradients. Fortunately, unlike non-cardiac surgery, cardiac surgery improves cardiac function in the majority of patients, and these patients have usually been extensively evaluated before being offered surgical repair. The anesthetic preoperative evaluation should also include a focus on pulmonary, neurological, and renal function, as preoperative impairment of these organ systems predisposes patients to myriad postoperative complications.