Browse the corpus

General lnternal Medicine . No survival beneflt is associated with revascularization in stable patients with CAD before noncardiac surgery unless they otherwise meet the general requirements for revascularization. Cardiovascular Risk Management Patients with a known recent MACE should not undergo elective surgery within: o 14 to 30 days of a bare metal coronary stent implantation for stable CAD . 3 to 6 months of a drug eluting coronary stent placement for stable CAD o 12 months after ACS Patients with hypertension who are undergoing surgery do not require urgent BP lowering preoperatively unless end organ dysfunction is evident. Most cardiac medications can be continued throughout the perioperative period. ACE inhibitors and ARBs are typically with- held ifprescribed for hyper-tension (unless BP is poorly controlled); diuretics are typically started as soon as possible postopera tively if prescribed for HF. DOil'T BE TRICKED . Do not routinely initiate p-blockers before surgery to reduce cardiovascular risk. . In the absence of ASCVD, do not routinely initiate statin therapy before surgery to reduce cardiovascular risk. o Do not use aspirin before surgery to reduce cardiovascular risk. . Do not choose routine postoperative surveillance with ECG or cardiac biomarkers unless symptoms of an ACS are present. Pulmonary Perioperative Management Screen all surgical patients for OSA with a validated tool such as the STOP BANG survey. Obtain polysomnography for patients with presumed OSA and initiate CPAP for patients with severe OSA undergoing high-risk elective surgical procedures. Preoperative inspiratory muscle training can reduce perioperative pulmonary complication rates by up to 507,. Smoking cessa- tion reduces pulmonary risk and should be encouraged as far in advance ofsurgery as possible. Select early mobilization and lung expansion maneuvers (deep breathing exercises, incentive spirometry) to prevent pulmonary complications. DOil'T BE TRICKED . Donotorderspirometryforriskassessmentintheabsenceofdyspneaorhypoxiaofuncertaincause. Perio pe rative Ma na gement of Anticoa g u la nt Thera py Anticoagulation must be stopped for most surgical procedures except those with minimal expected blood loss (cataract surgery dermatologic procedures, endoscopic procedures without biopsy).

DOil'T BE TRICKED . Donotorderspirometryforriskassessmentintheabsenceofdyspneaorhypoxiaofuncertaincause. Perio pe rative Ma na gement of Anticoa g u la nt Thera py Anticoagulation must be stopped for most surgical procedures except those with minimal expected blood loss (cataract surgery dermatologic procedures, endoscopic procedures without biopsy). o Stop warfarin 5 days before surgery. . Stopapixaban,rivaroxaban,anddabigatranlto2daysbeforesurgeryifeGFR>50ml/min/T.T3m2.StopearlierifeGFR is lower. Bridging anticoagulation involves providing heparin during the perioperative period until an oral anticoagulant is resumed Bridging should be considered only in patients taking warfarin with a high thrombotic risk: . high risk AF (e.g., CHATDS, VASc >7) . AF with mechanical valve 149