CHAPTER SUMMARY AND CENTRAL ILLUSTRATION
This chapter discusses the perioperative anesthetic management of patients with cardiovascular disease (CVD). Providing optimal perioperative care for CVD patients is a shared responsibility of cardiovascular clinicians, surgeons, and anesthesiologists. Any anesthetic agent or technique has the potential for producing adverse effects, and the margin of safety is reduced in CVD patients. As part of the multidisciplinary heart team, the cardiac anesthesiologist plays a central role in the shared decision-making regarding perioperative planning (see Fuster and Hurst’s Central Illustration). This planning includes preoperative evaluation and risk assessment, creation of safe intraoperative monitoring and management plans, and development of postoperative pain control regimens and fast-track recovery pathways. Cardiovascular effects of general, neuraxial, and regional anesthetic techniques, as well as the risks and benefits of noninvasive and invasive perioperative monitoring methods, must be considered. An area of continued growth is nonoperating room anesthetizing locations, which have specific needs. As CVD remains highly prevalent in surgical populations, the need for effective communication among the specialties of cardiology, surgery, and anesthesiology will remain critical in assuring optimal patient outcomes.
eFig 73-01 Chapter 73: Anesthesia and the Patient with Cardiovascular Disease
Providing safe anesthesia to patients with cardiovascular disease remains a great challenge. The constellation of anesthetic drug effects, the physiologic stresses of surgery, and underlying cardiovascular diseases can complicate and limit the choice of anesthetic techniques used for any specific procedure. The anesthesiologist’s approach to the patient with cardiovascular disease is to select agents and techniques that will optimize the patient’s cardiopulmonary function. The perioperative management of a patient with cardiovascular disease requires close cooperation between the cardiologist, interventionalist, intensivist, surgeon, and anesthesiologist. Each specialist has a unique knowledge base that complements that of the others. This multidisciplinary team approach should emphasize a continuum of care from the preoperative evaluation through the postoperative period.
As the complexity of patients with cardiovascular disease requiring surgical interventions has increased over the last few decades, the concept of a hospital “Heart Team” has slowly emerged.1-3 Specifically, it is a multidisciplinary decision-making team, tasked to select the most optimal treatment strategy for an individual patient.3 Such an approach has been successfully utilized in other medical fields, including oncology and organ transplant medicine, with reported significant improvements in the quality of care.4,5 Now this concept is emphasized in the context of treating patients with cardiovascular disease, becoming a standard of cardiovascular care worldwide.1,2
Although the exact composition of the Heart Team varies among institutions, in the cardiovascular arena, the noninvasive cardiologists, cardiac interventionalists, cardiac surgeons, and cardiac anesthesiologists are considered integral members of the institutional Heart Teams. In some cardiac subspecialties, such as myocardial revascularization, the Heart Team concept has ...