Figure - available from: Health Services Insights
This content is subject to copyright.
Source publication
Surgical management of disease has a tremendous impact on our health system. Millions of people worldwide undergo surgeries every year. Cardiovascular complications in the perioperative period are one of the most common events leading to increased morbidity and mortality. Although such events are very small in number, they are associated with a hig...
Citations
... The reduced cardiac reserve in these patients increases the risk of intraoperative and postoperative complications, making it imperative to optimize hemodynamic stability and nutritional status preoperatively. anesthesiologists and surgical teams must carefully consider the patient's NYHA classification and associated biochemical markers to tailor perioperative management strategies that minimize the risk of adverse outcomes [8,9,10]. ...
... 47,48 In the postoperative period, cardiac complications in elderly patients undergoing NCS are the most frequent cause of morbidity and mortality, occurring between 0.5 and 30% of cases. 49 During patient history and physical examination, anaesthetists can contribute to risk assessment and cardiac risk reduction. However, as reported in the National Confidential Enquiry into Perioperative Deaths registry, anaesthetists recorded an increased risk of death in only 66% of the patients who died. ...
... diabetes, hypertension, coronary artery disease), which could evolve into cardiac dysfunction and a further increased risk. 48, 49 We do not know if a cardiological consultation could improve the management of patients with 'heart stress', this should be investigated in future research. ...
... The HAA configuration strategy performs 1.55 times better than the HA configuration when considering the metabolic cost. In other words, taking advance of the work of Rafiq et al. (2017), it is possible to derive a simple linear equation from the following points: a walking speed of 4 km/h requires 2.9 MET. A walking speed of 1.7 km/h requires 2.3 MET. ...
Wearable robots are becoming a valuable solution that helps injured, and elderly people regain mobility and improve clinical outcomes by speeding up the rehabilitation process. The XoSoft exosuit identified several benefits, including improvement of assistance, usability, and acceptance with a soft, modular, bio-mimetic, and quasi-passive exoskeleton. This study compares two assistive configurations: (i) a bilateral hip flexion (HA, hips-assistance) and (ii) a bilateral hip flexion combined with ankle plantarflexion (HAA, hips-ankles-assistance) with the main goal of evaluating compensatory actions and synergetic effects generated by the human- exoskeleton interaction. A complete description of this complex interaction scenario with this actuated exosuit is evaluated during a treadmill walking task, using several indices to quantify the human-robot interaction in terms of muscular activation and fatigue, metabolic expenditure, and kinematic motion patterns. Evidence shows that the HAA biomimetic controller is synergetic with the musculature and performs better concerning the other control strategy. The experimentation demonstrated a metabolic expenditure reduction of 8% of Metabolic Equivalent of Task (MET), effective assistance of the muscular activation of 12.5%, a decrease of the muscular fatigue of 0.6% of the mean frequency, and a significant reduction of the compensatory actions, as discussed in this work. Compensatory effects are present in both assistive configurations, but the HAA modality provides a 47% reduction of compensatory effects when considering muscle activation.
... In case DAPT has to be discontinued for urgent or emergent surgery, such a decision should be individualized, weighting risks and benefits. 11 Discontinuation of aspirin may be responsible for 15% of all recurrent acute coronary syndromes in patients with documented stable coronary artery disease. Aspirin taken for secondary cardiac prevention should, in general, not be discontinued. ...
Preoperative cardiovascular management is an essential component of overall perioperative cardiovascular care. It involves preoperative detection and management of cardiovascular disease and prediction of both short-term and long-term cardiovascular risk. It affects anesthetic perioperative management and surgical decision making. This requires individualized management. Careful preoperative preparation at least a week before surgery, rational decisions regarding necessary tests and examinations, good cooperation with the cardiologist and surgeon and careful planning of early postoperative treatment are key for better outcome after surgery and reduction of postoperative complications.
... [7][8][9] Among factors that contribute to surgical delays, the need for preoperative cardiovascular risk stratification is significantly modifiable. 10 The American College of Cardiology (ACC)/American Heart Association (AHA) Task Force risk stratification framework for preoperative cardiac testing assists clinicians in determining surgical urgency, active cardiac conditions, cardiovascular risk factors, and functional capacity of each patient, and is well established for low-or intermediate-risk patients. 11 Specifically, metabolic equivalents (METs) measurements are used to identify medically stable patients with good or excellent functional capacity versus poor or unknown functional status. ...
... The spectrum of ventricular arrhythmias ranges from those that are benign and asymptomatic to those that produce severe symptoms including sudden cardiac death [4]. The paucity of studies that address surgical risk conferred by arrhythmias limits the ability to provide specific recommendations [1][2][3]5]. ...
... Analyses were done using the Mann-Whitney U-test: a comparison of maximum number of consecutive beats of VT by LVEF < 50% (n = 6) and ≥ 50% (n = 40), b comparison of number of VT episodes by LVEF < 50% (n = 6) and ≥ 50% (n = 40), c comparison of maximum number of consecutive beats of VT by BNP < 100 pg/mL (n = 32) and ≥ 100 pg/mL (n = 14), and d comparison of number of VT episodes by BNP < 100 pg/ mL (n = 32) and ≥ 100 pg/mL (n = 14). BNP B-type natriuretic peptide, LVEF left ventricular ejection fraction, NS not significant, VT ventricular tachycardia because of the limited number of studies to determine surgical risk in such cases [1][2][3]5]. A few studies have shown that supraventricular and ventricular arrhythmias are associated with a low risk of perioperative cardiac events [5,18,19]. ...
... BNP B-type natriuretic peptide, LVEF left ventricular ejection fraction, NS not significant, VT ventricular tachycardia because of the limited number of studies to determine surgical risk in such cases [1][2][3]5]. A few studies have shown that supraventricular and ventricular arrhythmias are associated with a low risk of perioperative cardiac events [5,18,19]. There is no increase in cardiac complications or any increased risk of nonfatal myocardial infarction or cardiac death in patients who have frequent ventricular premature beats, couplets, or NSVT in the perioperative period for noncardiac surgery [2,[5][6][7]. ...
The incidence of ventricular tachycardia (VT) in preoperative evaluation for noncardiac surgery in general hospitals has not been established. The aim of this study was to determine the incidence of VT, characteristics of patients with VT, characteristics of VT, and significance of VT in patients undergoing 24-h Holter monitoring as preoperative evaluation for noncardiac surgery. In 601 patients, VT was detected in 46 patients (7.7%). In patients with VT, left ventricular ejection fraction (LVEF) was lower (62.6 ± 9.3% vs. 66.6 ± 8.9%, p = 0.003), and B-type natriuretic peptide (BNP) was higher compared with patients without VT (median, 52.5 pg/mL vs. 32.8 pg/mL, p = 0.02). The maximum number of consecutive beats of VT was more frequent in the patients with LVEF < 50% than in the patients with LVEF ≥ 50% (median, 11.5 beats vs. 3.0 beats, p = 0.01). Forty patients (87%) underwent scheduled surgery without major complications.
... Рекомендации по методам обследования пациентов с брадиаритмиями Рекомендация 1. Всем пациентам с БА в предоперационный период необходимо провести консультацию кардиолога для уточнения заболевания, вызвавшего БА, с особым вниманием к выявлению преходящих, обратимых, причин БА, в том числе определяемых проводимым лечением [18]. (УДД -1, УУР -В). ...
... 35 However, mere presence of a serum creatinine level of > 1.5 or 2 mg/dl does not indicate that the patient may be at high risk if the patient is relatively young and not having other comorbidity or complications, and these patients can safely proceed for non-cardiac surgeries without further cardiac evaluation. 38,40 However, the scenario is not so rosy, especially in the low socioeconomic and developing countries where a good number of CKD patients present for the first time to the hospital with advanced grade/end stage renal disease. If the cause of the CKD is diabetes and the patient is either elderly or presenting with heart failure features, they will need further cardiac evaluation and optimization. ...
Chronic kidney disease is one of the leading co-morbidity at present. With the increasing prevalence of diabetes mellitus and hypertension, more and more peoples are developing diabetic and hypertensive nephropathy. As chronic kidney disease patient can present as an asymptomatic stable patient in one end and a multi-organ involved complicated end-stage disease in other ends, their management plan also varies. The serum creatinine levels of as low as 1.5 mg% have been linked to perioperative major cardiac events like myocardial infarction and arrest; these patients poses a challenge to the perioperative team. Moreover, a chance of developing acute kidney injury on the chronic kidney disease is also higher. These patients are also often elderly, with diabetes mellitus and/or hypertension. Therefore, accepting such patient for perioperative care needs systematic and meticulous approach. Preoperative assessment, risk stratification, and optimization play a great role. Both intraoperative and postoperative management needs a tailored approach. The present narrative review is prepared to give the current insight on these aspects.
... Patients in the risk group should have detailed assessment and then consultation with cardiology and it is important to prepare the patient in the best conditions for surgery and share risks based on this recommendation. Situations like acid-base balance disorder, electrolyte imbalances, cardiac pathologies, hypoxia and variations in body temperature that prepare the way for arrhythmias should be resolved at optimum levels to ensure the patient is stable (Rafiq et al., 2017). With regional anesthesia, patients should be more closely monitored for hypotension, bradycardia and sudden cardiac arrest, with patients monitored for rhythm, respiration and hemodynamics during every type of anesthesia administration. ...
BACKGROUND
When considering whether a patient is fit for surgery, a comprehensive patient assessment represents the first step for an anaesthetist to evaluate the risks associated with the procedure and the patient's underlying diseases, and to optimise (whenever possible) the perioperative surgical journey. These guidelines from the European Society of Anaesthesiology and Intensive Care Medicine (ESAIC) update previous guidelines to provide new evidence on existing and emerging topics that consider the different aspects of the patient's surgical path.
DESIGN
A comprehensive literature review focused on organisation, clinical facets, optimisation and planning. The methodological quality of the studies included was evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology. A Delphi process agreed on the wording of recommendations, and clinical practice statements (CPS) supported by minimal evidence. A draft version of the guidelines was published on the ESAIC website for 4 weeks, and the link was distributed to all ESAIC members, both individual and national, encompassing most European national anaesthesia societies. Feedback was gathered and incorporated into the guidelines accordingly. Following the finalisation of the draft, the Guidelines Committee and ESAIC Board officially approved the guidelines.
RESULTS
In the first phase of the guidelines update, 17 668 titles were initially identified. After removing duplicates and restricting the search period from 1 January 2018 to 3 May 2023, the number of titles was reduced to 16 774, which were then screened, yielding 414 abstracts. Among these, 267 relevant abstracts were identified from which 204 appropriate titles were selected for a comprehensive GRADE analysis. Additionally, the study considered 4 reviews, 16 meta-analyses, 9 previously published guidelines, 58 prospective cohort studies and 83 retrospective studies. The guideline provides 55 evidence-based recommendations that were voted on by a Delphi process, reaching a solid consensus (>90% agreement).
DISCUSSION
This update of the previous guidelines has covered new organisational and clinical aspects of the preoperative anaesthesia assessment to provide a more objective evaluation of patients with a high risk of postoperative complications requiring intensive care. Telemedicine and more predictive preoperative scores and biomarkers should guide the anaesthetist in selecting the appropriate preoperative blood tests, x-rays, and so forth for each patient, allowing the anaesthetist to assess the risks and suggest the most appropriate anaesthetic plan.
CONCLUSION
Each patient should have a tailored assessment of their fitness to undergo procedures requiring the involvement of an anaesthetist. The anaesthetist's role is essential in this phase to obtain a broad vision of the patient's clinical conditions, to coordinate care and to help the patient reach an informed decision.