Prevention Of Cardiac Ischemia In The Surgical Patient - California ...

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When Surgery cannot be Postponed • If surgery is urgent or emergent and clopidogrel must be interrupted, continue aspirin. • Restart Clopidogrel as soon as possible after surgery. • Consider giving antiplatelet therapy longer ( > one month for BM and >12 months for DES). Practice alert for the perioperative management of pts with coronary artery stents. Anesthesiology V110, No1, Jan 2009; Coronary artery stents. Anesthesiology V107, No2, August 2009
Case Study #1 • 70 year old male, 84 kg, 70 inches, NKDA scheduled for laparoscopic cholecystectomy • History: CAD, ischemic cardiomyopathy, bilateral carotid artery stenosis, CHF, HTN, MI in past, hyperlipidemia, CVA, arrhythmias • <strong>Surgical</strong> history: CABG X3 10 yrs ago, pacemaker one year ago • Meds: Coumadin, Isordil, metoprolol, HCTZ, ASA Pravastatin, iron
Page 1 and 2: Prevention of Cardiac Ischemia in t
Page 3 and 4: Case Study • 85-year-old, 50-kg f
Page 5 and 6: Heart Disease & Smoking • Smokers
Page 7 and 8: Heart Disease and Surgery • Of th
Page 9 and 10: Anesthesia and Ischemia
Page 11 and 12: Sensitivity to Detect Ischemia •
Page 13 and 14: How healthy is the patient? Good LV
Page 15 and 16: Impaired LV Function • EF < 40%
Page 17 and 18: Perioperative Myocardial Ischemia
Page 19 and 20: Types of MIs • According to the s
Page 21 and 22: Anesthetic Goal Reduce the incidenc
Page 23 and 24: Anesthetic Choice • Each type of
Page 25 and 26: Importance of Prevention A single e
Page 27 and 28: Balance Supply & Demand • Increas
Page 29 and 30: Alpha 2 Adrenergic Agonists • Clo
Page 31 and 32: Calcium Channel Blockers • Arteri
Page 33 and 34: Selective Beta Blockers • Beta bl
Page 35 and 36: What about the use of beta blockers
Page 37 and 38: ACC/AHA 2004 Perioperative Guidelin
Page 39 and 40: POISE Study • In the Toprol group
Page 41 and 42: Advice on Beta Blockers • Continu
Page 43 and 44: 2007 STEMI Recommendations • Risk
Page 45 and 46: Treatment of Ischemia • Morphine
Page 47 and 48: Patient with a Cardiac Stent • Si
Page 49: When Surgery cannot be Postponed an
Page 53 and 54: Should surgery proceed?
Page 55 and 56: Case Study #2 • Surgery postponed
Page 57 and 58: Case Study #3 • 52 yr old female
Page 59 and 60: Case Study #5 • 74 year-old, 86 k
Page 61 and 62: Summary: Bare Metal Stents • Dela

Prevention Of Cardiac Ischemia In The Surgical Patient - California ...

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