Risk reduction strategies for cardiac patients
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1. The document discusses risk reduction strategies for cardiac patients undergoing non-cardiac surgery, including preoperative risk stratification, coronary revascularization, pharmacological therapies, anesthetic considerations, and postoperative monitoring. 2. It provides recommendations on preoperative coronary revascularization for high-risk patients, as well as perioperative use of beta-blockers, statins, alpha-2 agonists, aspirin, calcium channel blockers, and nitroglycerin to reduce cardiac risks. 3. Intraoperatively, it recommends maintaining normothermia, considers the use of volatile anesthetics, and suggests using intraoperative echocardiography for acute hemodynamic issues. Tight control of blood glucose is also addressed.
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Draft que encontrei de apresentação em 201: Primeiro Encontro de Medicina Hospitalista da Argentina. Slides alguns já traduzidos, outros não - não encontrei versão final. De brasileiros no evento participaram eu, Lucas Zambon e Tiago Daltoé. Boas lembranças! Resgatei agora porque trata de evidência consolidada desde aquela época, e seguimos sobreutilizando o recurso. Ou algo novo que justifique?
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The reader should be able to:
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Perioperative myocardial ischaemia in non cardiac surgery-ppt
This document discusses myocardial ischemia and infarction in the surgical population. It defines myocardial ischemia as insufficient blood flow to the heart muscle and myocardial infarction as death of heart muscle cells due to prolonged ischemia. The document notes that myocardial ischemia can lead to infarction and is a major cause of short and long term morbidity and mortality in surgical patients. It provides details on the pathophysiology, diagnosis, incidence, risk factors, and strategies for prevention and management of perioperative myocardial ischemia.
Perioperative cardiovascular assessment of patients undergoing noncardiac sur...
Perioperative cardiovascular assessment is necessary for patients undergoing noncardiac surgery to evaluate medical status, cardiac risks, and recommend strategies to improve short and long term outcomes. Surgeries are stratified as low, intermediate, or high risk depending on the procedure. For patients at elevated risk, further testing like stress testing may be considered to guide management. Guidelines recommend continuing medications like beta blockers and statins perioperatively, as well as delaying surgery for patients with stents based on type. The timing and risks of surgery must be weighed based on a patient's cardiovascular condition and procedure.
Non cardiac surgery in cardiac patients mo
This document discusses guidelines for evaluating and managing cardiac risk in patients undergoing non-cardiac surgery. It outlines factors that increase surgical risk like prolonged stress and changes in thrombotic factors. Complication rates are reported to be 7-11% with 0.8-1.5% mortality depending on precautions. Up to 42% of complications are cardiac related. It provides recommendations on pre-operative testing and risk stratification using indices. Risk reduction strategies discussed include use of beta-blockers, statins, and revascularization. Perioperative management of antiplatelets and anticoagulants is also covered.
Cardiac Evaluation Ppt!
The document discusses guidelines for pre-operative cardiac evaluation to identify patients at risk of peri-operative complications and determine the need for interventions. It outlines goals of evaluating a patient's history, physical exam, and tests to determine cardiac risk. Non-invasive tests include ECG, stress testing, and echocardiogram. Surgical risk is stratified as high, moderate, low. Guidelines provide a framework to screen patients. The evaluation involves assessing risk factors, functional capacity, surgical risk to categorize patients and guide management through anesthesia, medical optimization, or possible revascularization.
Pro Operative Cardiac Clearence For Non Cardiac Surgery
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2. It outlines evaluating a patient's history, examination, and selecting appropriate investigations to determine their cardiac risk level.
3. Specific high-risk cardiac conditions like coronary artery disease, heart failure, arrhythmias and valvular diseases warrant detailed assessment of prognosis and management during the perioperative period.
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This document outlines key aspects of perioperative care for cardiac surgery patients, including:
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Perioperative cardiac assessment for non-cardiac surgery
Non-cardiac surgery represents an opportunity to assess patients' short-term and long-term cardiac risk and treat any significant cardiac diseases or risks. The referring physician should inform patients of the evaluation results and implications for their prognosis. Further, physicians should avoid stating a patient is "cleared for surgery" and instead focus on perioperative cardiac optimization and management of risks.
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Patient undergoing non-cardiac surgery represents an opportunity to assess cardiac risk both in the short and long term. A full evaluation should be performed to understand prognosis and any need for treatment of underlying cardiac conditions or risks. The referring physician should be informed of the evaluation results and their implications. Patients should not be described as simply "cleared for surgery".
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This document discusses perioperative cardiac medication management in high-risk patients. It covers various cardiac conditions, medications including beta-blockers, calcium channel blockers, ACE inhibitors, diuretics, nitrates, and amiodarone. It provides recommendations on continuing or holding medications pre- and post-operatively based on the medication class and surgical risk. Key recommendations include continuing beta-blockers and statins for most patients, considering holding ACE inhibitors and diuretics pre-operatively, and weighing risks and benefits of holding versus continuing other medications individually based on condition and surgery type.
Preoperative care by Dr Nipun Bansal
This document outlines principles of preoperative care. It discusses evaluating patients' medical history and comorbidities, explaining the planned procedure to obtain informed consent, optimizing high-risk medical conditions before surgery, assessing surgical risk, and preparing patients with bowel cleansing or stopping certain medications. The goal is to minimize risks and optimize outcomes through thorough preoperative evaluation, planning, and preparation.
PCI complications
This document discusses complications that can occur during percutaneous coronary intervention (PCI), specifically contrast-induced nephropathy and coronary perforation. It defines contrast-induced nephropathy as acute kidney injury occurring after administration of radiocontrast media. Coronary perforation is defined as extravasation of contrast or blood from the coronary artery during or after PCI. The document discusses risk factors, prevention, diagnosis and management of these complications.
Pre operative cardiac assessment dr sadany-1
This document discusses perioperative cardiac risk assessment and management. It covers pre-operative evaluation of patient risk factors and conditions, classification of surgical procedures by urgency, predictors of perioperative cardiac complications, and recommendations for testing and treatment based on patient risk profile and functional capacity. The goal is to stratify patient risk and determine optimal management to reduce complications during surgery and recovery.
2014-Perioperative-Slide-Set (2).ppt
This document provides guidelines and recommendations for perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. It was developed by an expert panel representing multiple medical societies. The guidelines cover evaluation of cardiovascular risk factors and diseases, methods for assessing cardiac risk prior to surgery, and recommendations for perioperative medical therapy management. The level of evidence and class of recommendations are provided for each statement to help guide clinical decision making.
Preoperative evaluation
This document provides guidelines for pre-operative evaluation and risk assessment. It discusses evaluating patients' medication use, medical conditions, functional status, and surgery-specific risk. Key factors that increase cardiac risk include recent heart attack, heart failure, diabetes, and poor functional status. Testing may be warranted for intermediate-high risk surgery or patients with a predicted >1% risk of major cardiac events. Continuation of most medications is reasonable. Statins, aspirin, and beta-blockers in selected patients can reduce risk. Timing of elective surgery depends on prior stenting or heart attack. The goal is to identify and optimize modifiable risks to reduce complications.
Kidney Preoperative Management.pptx
Identify the etiology of perioperative hypertension.
Outline the appropriate evaluation of perioperative hypertension.
Review the management options available for perioperative hypertension
09 hashem et al
Thoracoabdominal aortic aneurysms (TAAAs) involve the thoracic and abdominal aorta. They account for 10% of aortic aneurysms and are challenging for anesthesiologists due to risks of paraplegia, renal failure, and other complications during surgery. Pre-operative evaluation of cardiac, pulmonary, and renal function is important for risk assessment and stratification. Proper management and optimization of any co-morbidities is also key to achieving a good surgical outcome.
Perioperative Cardiovascular Evaluation for Non-cardiac surgery - Toufiqur Ra...
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perioperative cardiovascular evaluation, non-cardiac surgery, Hypertension,Valvular Heart Disease ,Myocardial Disease, Arrhythmias and Conduction Abnormalities,Implantable Pacemakers or ICDs.Similar to Risk reduction strategies for cardiac patients (20)
Does Preoperative Coronary Revascularization Improve Perioperative Cardiac Ou...
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Perioperative cardiac assessment for non-cardiac surgery
Perioperative cardiac assessment for non-cardiac surgery
Optimising physiological-endpoints-of-percutaneous-coronary-intervention(1)
Optimising physiological-endpoints-of-percutaneous-coronary-intervention(1)
International Journal of Clinical Cardiology & Research
International Journal of Clinical Cardiology & Research
PAC clearance in patients with neurological diseases recommendations
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Perioperative cardiac medications in high risk patients
Perioperative cardiac medications in high risk patients
Perioperative Cardiovascular Evaluation for Non-cardiac surgery - Toufiqur Ra...
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Routine cpb weaning
This document discusses routine weaning from cardiopulmonary bypass (CPB). It emphasizes the importance of clear communication among the perfusionist, surgeon, and anesthesiologist during weaning. The process begins by partially occluding venous return to allow the heart to fill and pump on its own. Key parameters like pump flow rate, reservoir volume, and oxygen saturation are monitored. As flow rate decreases, preload is adjusted through small volume boluses to achieve optimal hemodynamics before fully discontinuing CPB support. Challenges like hypovolemia or pump failure are addressed through interventions like volume infusion or reinstituting bypass. Careful monitoring and prompt response are essential during this critical transition off bypass.
Preparation for separation 2010 final
This document discusses preparation for weaning a patient from cardiopulmonary bypass (CPB) during cardiac surgery. It emphasizes the importance of general preparations like ensuring rewarming, optimizing blood chemistry, and removing air from the heart. Preparing the lungs and heart is also important. This involves reinflating the lungs, optimizing the heart's rhythm, rate, contractility, afterload and preload. Electrical pacing may be needed to establish an effective cardiac rhythm before terminating CPB. Inotropic support can be provided if low contractility is detected. The goal is to have the heart in the best condition possible before ending CPB support.
Cardiac physiology abeer 1
The document describes the physiology of the heart, including its muscular wall, conductive system, cardiac action potential, and excitation-contraction coupling. It discusses how electrical signals are initiated in the heart and conducted between cells, causing contraction. Finally, it summarizes how different anesthetics can impact the heart's electrical and mechanical functions by altering ion channels and calcium handling.
Physiological considerations and patient positioning during anesthesia for th...
This document discusses ventilation/perfusion relationships and the lateral decubitus position. It explains the advantages of the lateral position for surgical access but also the disadvantages like ventilation/perfusion mismatch and pressure injuries. Anesthesia, positive pressure ventilation, and open pneumothorax can also cause mismatches. Complications of the lateral position include peripheral nerve injuries, vascular issues, and retinal damage, but can be prevented with proper positioning support and padding.
Abeer elnakera
The document discusses acute kidney injury (AKI) following cardiac surgery. It describes the RIFLE classification system for defining AKI severity. It identifies risk factors for AKI including pre-existing medical conditions, operative factors like bypass time, and early postoperative complications. Methods for predicting, preventing, and managing AKI are covered, including biomarkers for early detection and continuous renal replacement therapy for treatment of severe cases.
Abeer elnakera
The document describes RIFLE classification of acute kidney injury and discusses risk factors, causes, prediction, prevention and management of AKI after cardiac surgery. It also examines biomarkers used for early diagnosis of AKI and notes that continuous renal replacement therapy is often preferred over other modalities for treating AKI patients in the intensive care unit.
Routine cpb weaning
The document outlines the steps for routinely weaning a patient from cardiopulmonary bypass (CPB). It begins with partially occluding venous return to fill the heart and establish pulsatile arterial flow. The perfusionist gradually decreases pump flow while communicating three parameters: flow rate, reservoir volume, and oxygen saturation. As weaning progresses, the patient is assessed for hemodynamic stability before fully clamping venous return and turning off pump flow. Post-bypass, patients are categorized and carefully monitored, with interventions like fluids, drugs or devices as needed to stabilize their condition.
Preparation for separation 2010 final
1. Preparation for weaning a patient from cardiopulmonary bypass (CPB) involves optimizing several physiological parameters including temperature, blood pressure, cardiac rhythm and contractility, blood gases, and fluid balance.
2. The heart is prepared for weaning through steps like ensuring adequate rewarming, optimizing heart rate and rhythm, increasing contractility if needed, and adjusting preload and afterload.
3. Final preparations include optimizing monitoring, drugs, equipment, ventilation, and addressing any surgical concerns prior to attempting to wean the patient from bypass.
Cardiopulmonary bypass
Cardiopulmonary bypass (CPB) involves diverting blood from the heart to an external circuit for oxygenation and pumping. The basic components are a venous reservoir, oxygenator, heat exchanger, pump, and arterial filter. Initiation requires careful monitoring as the patient is transitioned to bypass. Management on CPB maintains appropriate pump flow, mean arterial pressure, temperature, and organ perfusion through monitoring of multiple parameters.
Preoperative management
The document discusses preoperative evaluation and management of patients undergoing cardiac surgery. It covers evaluating the patient's cardiovascular status through medical history, physical exam, tests like ECG, chest x-ray, stress testing, echocardiography and cardiac catheterization. Key aspects of preoperative evaluation are understanding the planned surgery, assessing medical conditions, identifying risks, advising on medication management, and determining a prognosis. The goals are to optimize the patient for surgery and form an intraoperative and postoperative plan.
CAafter cardiac surgery
The document provides guidelines for diagnosing and managing cardiac arrest in cardiac surgical patients, noting they require rapid diagnosis and treatment such as immediate defibrillation if needed. It outlines the cardiac arrest protocol including defibrillation, medications, pacing, basic life support, and performing emergency resternotomy to access the heart if initial resuscitative efforts are unsuccessful. The guidelines emphasize the importance of teamwork and defined roles to efficiently manage the cardiac arrest according to the protocol.
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