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

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Heart Disease and Surgery • 400,000 per year will have cardiac surgery 25% will have perioperative CV morbidity • 30 million will have noncardiac surgery 5% (1.5 million) will have perioperative CV morbidity with half of these people suffering an MI More than half of the deaths after surgery will be caused by cardiac events
Heart Disease and Surgery • <strong>Of</strong> those at risk for perioperative complications, ischemia occurs in 20-40% • Pts with episodes of ischemia are more likely to die within the next 2 years • Associated with a 9-fold increase in risk of cardiac death, MI, or unstable angina • <strong>Patient</strong> may be asymptomatic until 70% or more occlusion occurs
Page 1 and 2: Prevention of Cardiac Ischemia in t
Page 3 and 4: Case Study • 85-year-old, 50-kg f
Page 5: Heart Disease & Smoking • Smokers
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 and 50: When Surgery cannot be Postponed an
Page 51 and 52: Case Study #1 • 70 year old male,
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
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Prevention Of Cardiac Ischemia In The Surgical Patient - California ...

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