The internist frequently is called upon by his surgical colleagues for an opinion concerning the risk of anesthesia and a surgical procedure in a patient who has organic heart disease. The opinion given must be based on several considerations, for the request carries with it a number of implied questions. The most important of these questions are:
Will the anesthesia and surgical operation increase the demands upon the heart beyond the limits of the cardiac reserve and therefore precipitate congestive heart failure?
Does the heart require treatment before operation?
Is the prognosis of the heart condition so grave that operation should be avoided if possible or limited to an emergency or palliative procedure?
Is the heart condition such that it carries with it the liability to sudden death during anesthesia and surgery?
What bearing does the state of the heart have on the choice of the anesthetic?
What, if any, cardiovascular complications are to be anticipated during the operation and postoperative period?
The information necessary to answer these questions usually can be obtained from the clinical history and physical examination alone without resorting to more elaborate forms of investigation.
It is still quite commonly believed that during anesthesia and surgical operation the heart is subjected to a considerably increased demand for work. There is no evidence, however, that such is actually the case. The two greatest dangers to which a patient is exposed during an operation under general anesthesia are anoxia and shock. If. . .