The AHA Guidelines and Scientific Statements Handbook

Perioperative Cardiovascular

Evaluation and Care for Noncardiac

Surgery

Lee A. Fleisher

8

Introduction

General approach to the patient

Stepwise approach to perioperative cardiac assessment

Recommendations

Recommendations for preoperative noninvasive

evaluation of left ventricular function

Recommendations for preoperative resting 12-lead ECG

Recommendations for noninvasive stress testing before

noncardiac surgery

Recommendations for preoperative coronary

revascularization with coronary artery bypass

grafting or percutaneous coronary intervention

Recommendations for beta-blocker medical therapy

Recommendations for statin therapy

Recommendations for alpha-2 agonists

Recommendation for preoperative intensive care

monitoring

Recommendation for use of volatile anesthetic agents

Recommendation for prophylactic intraoperative

nitroglycerin

Recommendation for use of transesophageal

echocardiography

Recommendation for maintenance of body

temperature

Recommendations for perioperative control of blood

glucose concentration

Recommendations for perioperative use of pulmonary

artery catheters

This is a Report of the American College of Cardiology/

American Heart Association Task Force on Practice Guide-

lines (Writing Committee to Revise the 2002 Guidelines on

Perioperative Cardiovascular Evaluation for Noncardiac

Surgery). Developed in Collaboration With the American

Society of Echocardiography, American Society of Nuclear

Cardiology, Heart Rhythm Society, Society of Cardiovascular

Anesthesiologists, Society for Cardiovascular Angiography

and Interventions, Society for Vascular Medicine and Biology,

and Society for Vascular Surgery.

Writing committee members

Lee A. Fleisher, MD, FACC, FAHA, Chair; Joshua A. Beckman,

MD, FACC¶; Kenneth A. Brown, MD, FACC, FAHA†; Hugh

Calkins, MD, FACC, FAHA‡; Elliott Chaikof, MD#; Kirsten E.

Fleischmann, MD, MPH, FACC; William K. Freeman, MD,

FACC*; James B. Froehlich, MD, MPH, FACC; Edward K.

Kasper, MD, FACC; Judy R. Kersten, MD, FACC; Barbara

Riegel, DNSc, RN, FAHA; John F. Robb, MD, FACC||

ACC/AHA task force members

Sidney C. Smith, Jr, MD, FACC, FAHA, Chair; Alice K. Jacobs,

MD, FACC, FAHA, Vice Chair; Cynthia D. Adams, MSN,

PhD, FAHA†; Jeffrey L. Anderson, MD, FACC, FAHA††;

Elliott M. Antman, MD, FACC, FAHA**; Christopher E.

Buller, MD, FACC; Mark A. Creager, MD, FACC, FAHA;

Steven M. Ettinger, MD, FACC; David P. Faxon, MD, FACC,

FAHA††; Valentin Fuster, MD, PhD, FACC, FAHA††; Jona-

than L. Halperin, MD, FACC, FAHA††; Loren F. Hiratzka,

MD, FACC, FAHA††; Sharon A. Hunt, MD, FACC, FAHA††;

Bruce W. Lytle, MD, FACC, FAHA; Rick Nishimura, MD,

FACC, FAHA; Joseph P. Ornato, MD, FACC††; Richard L.

Page, MD, FACC, FAHA; Barbara Riegel, DNSc, RN, FAHA††;

Lynn G. Tarkington, RN; Clyde W. Yancy, MD, FACC

* American Society of Echocardiography Offi cial

Representative.

† American Society of Nuclear Cardiology Offi cial

Representative.

‡ Heart Rhythm Society Offi cial Representative.

§ Society of Cardiovascular Anesthesiologists Offi cial

Representative.

|| Society for Cardiovascular Angiography and Interventions

Offi cial Representative.

¶ Society for Vascular Medicine and Biology Offi cial

Representative.

# Society for Vascular Surgery Offi cial Representative.

** Immediate Past Chair.

†† Former Task Force member during this writing effort.

The AHA Guidelines and Scientific Statements Handbook
Edited by Valentin Fuster © 2009 American Heart Association
ISBN: 978-1-405-18463-2