What are the pre-anesthetic concerns in the patient with coronary artery disease?

What are the pre-anesthetic concerns in the patient with coronary artery disease?

Pre-anesthetic anxiety will cause patients to develop tachycardia. Patients with coronary artery disease should have adequate anxiolysis, in the form of either pharma-cology or counseling, so that they do not have a dramatic increase in oxygen consumption.

Patients with coronary artery disease also have concomi-tant diseases such as hypertension and diabetes. Patients with severe diabetes mellitus may be at risk for autonomic and peripheral neuropathy. That is the reason why silent ischemia is so prevalent in the diabetic patient. Diabetic patients may also have delayed gastric emptying if auto-nomic neuropathy is present. Appropriate prophylaxis for a full stomach should be considered.

Patients with hypertension have intravascular hypo-volemia and may present with hypotension upon induction of anesthesia. It is important to ascertain the volume status of the patient prior to induction and to volume-load the patient to prevent hypotension. The response to laryngoscopy may include tachycardia, which increases oxygen consump-tion. Medication (narcotics, β-blockers, lidocaine) must be administered to patients with coronary artery disease to ensure that they have a blunted catecholamine release in response to intubation.