Care of the cardiac patient after noncardiac surgery
The importance of avoiding cardiac “asphyxial strain” during the operative period has been recognized from the early twentieth century. Perhaps because these patients have a wide range of problems, few studies have been directed to the immediate postoperative care of the cardiac patient who has been given anesthesia for general surgery.
The care of the patient must be individualized to the extent of the disease and condition, and postoperative management should be an extension of careful preoperative studies for definition of extent of myocardial compromise and compensation measures, and intraoperative care. An example of this would be two patients with symptomatic coronary artery disease, the first whose anginal symptoms have not changed in frequency or duration for years and the second who has experienced increasing angina after a recent infarction and symptoms of congestive heart failure. The second patient would require extensive preoperative studies, if time permits, possibly including angiography, and extensive intraoperative and postoperative monitoring with increased need for pharmacologic intervention. The first patient would require attention primarily to the basic hemodynamics resulting in decreased myocardial oxygen demand, without extensive intraoperative or postoperative invasive monitoring. A recent study showed a correlation between preoperative heart failure and increased postoperative heart failure or pulmonary edema.1 Cardiac patients entering the operating room with a history of heart failure, functional New York Heart Association Class IV with jugular venous distention and S3 gallop, a history of pulmonary edema, and left-sided heart failure confirmed by examination or roentgenography are almost certain to require intense . . .