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EAGLE ET AL., PERIOPERATIVE CARDIOVASCULAR EVALUATION FOR NONCARDIAC SURGERY UPDATE
http://www.acc.org/clinical/guidelines/perio/update/periupdate_index.htm

ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery

A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)


Committee Members
Kim A. Eagle, MD, FACC, Chair; Peter B. Berger, MD, FACC; Hugh Calkins, MD, FACC; Bernard R. Chaitman, MD, FACC; Gordon A. Ewy, MD, FACC; Kirsten E. Fleischmann, MD, MPH, FACC; Lee A. Fleisher, MD, FACC; James B. Froehlich, MD, FACC; Richard J. Gusberg, MD, FACS; Jeffrey A. Leppo, MD, FACC; Thomas Ryan, MD, FACC; Robert C. Schlant, MD, FACC; William L. Winters, Jr, MD, MACC

Task Force Members
Raymond J. Gibbons, MD, FACC, Chair; Elliott M. Antman, MD, FACC, Vice Chair; Joseph S. Alpert, MD, FACC; David P. Faxon, MD, FACC; Valentin Fuster, MD, PhD, FACC; Gabriel Gregoratos, MD, FACC; Alice K. Jacobs, MD, FACC; Loren F. Hiratzka, MD, FACC; Richard O. Russell, MD, FACC; Sidney C. Smith, Jr, MD, FACC


Preamble

I. Definition of the Problem

  1. Purpose of These Guidelines
  2. Methodology and Evidence
  3. Epidemiology
  4. Practice Patterns
  5. Financial Implications
  6. Role of the Consultant

II. General Approach to the Patient

  1. History
  2. Physical Examination
  3. Comorbid Diseases
    1. Pulmonary Disease
    2. Diabetes Mellitus
    3. Renal Impairment
    4. Hematologic Disorders
  4. Ancillary Studies
  5. Stepwise Approach to Perioperative Cardiac Assessment

III. Disease-Specific Approaches

  1. Coronary Artery Disease
    1. Patients With Known CAD
    2. Patients With Major Risk Factors for CAD
  2. Hypertension
  3. Heart Failure
  4. Cardiomyopathy
  5. Valvular Heart Disease
  6. Arrhythmias and Conduction Defects
  7. Implanted Pacemakers and ICDs
  8. Pulmonary Vascular Disease

IV. Type of Surgery

  1. Urgency
  2. Surgical Risk

V. Supplemental Preoperative Evaluation

  1. Shortcut to the Decision to Test
  2. Resting Left Ventricular Function
  3. Assessment of Risk for CAD and Functional Capacity
    1. The 12-lead ECG
    2. Exercise Stress Testing for Myocardial Ischemia and Functional Capacity
    3. Nonexercise Stress Testing
    4. Myocardial Perfusion Imaging Methods
    5. Dobutamine Stress Echocardiography
    6. Stress Testing in the Presence of Left Bundle-Branch Block
    7. Ambulatory ECG Monitoring
  4. Recommendations: When and Which Test

VI. Implications of Risk Assessment Strategies for Costs

VII. Perioperative or Previous Coronary Revascularization

  1. Rationale for Surgical Coronary Revascularization and Summary of Evidence
    1. Preoperative CABG
    2. Preoperative PCI
  2. Perioperative Medical Therapy
  3. Valve Surgery
  4. Arrhythmia and Conduction Disturbances
  5. Implanted Pacemakers and ICDs
  6. Preoperative Intensive Care
  7. Venothromboembolism/Peripheral Arterial Disease

VIII. Anesthetic Considerations and Intraoperative Management

  1. Choice of Anesthetic Technique and Agent
  2. Perioperative Pain Management
  3. Intraoperative Nitroglycerin
  4. Use of TEE
  5. Maintenance of Body Temperature
  6. Intra-Aortic Balloon Counterpulsation Device

IX. Perioperative Surveillance

  1. Intraoperative and Postoperative Use of Pulmonary Artery Catheters
  2. Intraoperative and Postoperative Use of ST-Segment Monitoring
  3. Surveillance for Perioperative MI
  4. Arrhythmia/Conduction Disease Disorders

X. Postoperative and Long-Term Management

XI. Conclusions

XII. Cardiac Risk of Noncardiac Surgery: Areas in Need of Further Research

Staff

Appendix 1 - Definition of Terminology

Appendix 2 - Abbreviations

References

Figures & Tables

This document was approved by the American College of Cardiology Board of Trustees in December 2001 and the American Heart Association Science Advisory and Coordinating Committee in November 2001. When citing this document, the American College of Cardiology and the American Heart Association would appreciate the following citation format: Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE, Fleisher LA, Froehlich JB, Gusberg RJ, Leppo JA, Ryan T, Schlant RC, Winters WL Jr. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery update: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). 2002. American College of Cardiology Web site. Available at: http://www.acc.org/clinical/guidelines/perio/update/periupdate_index.htm

Address for reprints: a copy of this document (the complete guidelines) is available online only. To obtain a reprint of the shorter version (Executive Summary) published in the February 6, 2002 issue of the Journal of the American College of Cardiology and the March 5, 2002 issue of Circulation, cal 800-253-4636 (US only) or write the American College of Cardiology, Educational Services, 9111 Old Georgetown Road, Bethesda, MD 20814-1699 and ask for reprint No. 71-0218. The cost is $5. To purchase additional reprints (specify version and reprint number): up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies, call 214-706-1466, fax 214-691-6342; or e-mail pubauth@heart.org.

 

Copyright © 2002 by the American College of Cardiology and American Heart Association, Inc.

 

 

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