Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines (guidelines) with recommendations to improve cardiovascular health. In 2013, the National Heart, Lung, and Blood Institute (NHLBI) Advisory

http://kidneys.zaslavsky.com.ua/article/download/122220/118980

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000597

Jeffrey L. Anderson, MD, FACC, FAHA, Chair 

Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect 

Nancy M. Albert, PhD, RN, FAHA

Biykem Bozkurt, MD, PhD, FACC, FAHA

Ralph G. Brindis, MD, MPH, MACC

Lesley H. Curtis, PhD, FAHA

David DeMets, PhD[¶¶][1]

Lee A. Fleisher, MD, FACC, FAHA

Samuel

/pdf/2014-acc-aha-guideline-on-perioperative-cardiovascular-3firuin78y.pdf

2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: A report of the American college of cardiology/American heart association task force on practice guidelines

Anesthesiology. First of two parts.

http://unmhospitalist.pbworks.com/f/ACC+Preoperative+risk+2008.pdf

ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)

The cardiovascular responses to the induction, maintenance, and recovery from anaesthesia with thiopentone, nitrous oxide and halothane, have been studied in seven elderly normotensive patients, seven untreated hypertensive patients, and fifteen patients under treatment with a variety of anti-hypertensive drugs. In five untreated and three treated hypertensive patients, all of whom had high arterial pressures before anaesthesia, severe reduction of arterial pressure occurred during anaesthesia and was associated with electrocardiographic evidence of myocardial ischaemia. Other treated hypertensive patients, whose arterial pressures were well controlled, behaved in a similar manner to the normotensive patients, and gave no ground for concern during anaesthesia. Cardiac output fell to the same extent (30 per cent) in all three groups, and where a great reduction of arterial pressure occurred it was largely due to reduction of initially high systemic vascular resistance. Baroreflex control of heart rate was significantly depressed in hypertensive patients both before and during anaesthesia. It is concluded that untreated high arterial pressure constitutes a serious risk to patients undergoing anaesthesia and surgery, and therefore anti-hypertensive therapy should not be withdrawn prior to anaesthesia without a compelling reason.

Studies of anaesthesia in relation to hypertension i: cardiovascular responses of treated and untreated patients

The effects of intravenous practolol 0.4 mg/kg were studied in 12 hypertensive patients during halothane/nitrous oxide anaesthesia. Practolol decreased heart rate (HR) and cardiac output
				 \( Q ˙ \) from the elevated levels following atropine administration during anaesthesia, but values of arterial pressure (AP), HR and
				 Q ˙ after the combination of atropine and practolol were not significantly different from those during anaesthesia prior to blockade. The effects of a similar anaesthetic sequence were studied in a further 11 treated hypertensive patients given practolol by mouth 1.5 mg/kg/6 hours for at least 48 hours preoperatively in addition to current anti-hypertensive therapy. By comparison with treated hypertensive patients previously studied, those pretreated with practolol had similar AP awake, but higher AP throughout anaesthesia with either spontaneous or artificial ventilation. Cardiac output was higher and systemic vascular resistance was lower both before and during anaesthesia. Both the present groups of patients showed significantly attenuated responses of tachycardia and hypertension following laryngoscopy and intubation compared with previous studies. The incidence of dysrhythmia and e.c.g. evidence of myocardial ischaemia was significantly lower (4%) in beta-blocked patients compared with those who had not received practolol (38%).

Studies of anaesthesia in relation to hypertension v: adrenergic beta-receptor blockade

The utility of interventional cardiology has developed significantly over the last two decades with the introduction of coronary angioplasty and stenting, with the associated antiplatelet medications. Acute coronary stent occlusion carries a high morbidity and mortality, and the adoption of therapeutic strategies for prophylaxis against stent thrombosis has major implications for surgeons and anaesthetists involved in the management of these patients in the perioperative period. Currently, there is limited published information to guide the clinician in the optimal care of patients who have had coronary stents inserted when they present for non-cardiac surgery. This review examines the available literature on the perioperative management of these patients. A number of key issues are identified: the role of surgery vs percutaneous coronary intervention for coronary revascularization in the preoperative period; the different types of coronary stents currently available; the emerging issues related to drug-eluting stents; the pathophysiology of coronary stent occlusion; and the recommended antiplatelet regimes that the patient with a coronary stent will be receiving. The role of preoperative platelet function testing is also discussed, and the various available tests are listed. Appropriate management by all the clinicians involved with patients with coronary stents undergoing a variety of non-cardiac surgical procedures is essential to avoid a high incidence of postoperative cardiac mortality and morbidity. The review examines the evidence available for the perioperative strategies aimed at reducing adverse outcomes in a number of different clinical scenarios.

Coronary artery stents and non-cardiac surgery

Three patients presenting for elective aortic surgery were studied before operation and for up to 3 days after operation with ambulatory electrocardiographic monitoring and nocturnal pulse oximetry Supplementary oxygen was administered for the first 2 days after operation and withdrawn on the 3rd morning after operation Heart rate remained increased for the first 3 days after operation Two patients developed episodes of myocardial ischaemia during the first 48 h after operation while their arterial oxygen saturation remained greater than 90% On the third day, and during the third night after operation, both the severity and duration of myocardial ischaemia increased markedly, associated with arterial hypoxaemia A temporal relationship between decreases in oxygen saturation and fluctuations in ST segment level were observed in the three patients

Postoperative myocardial ischaemia: temporal association with nocturnal hypoxaemia

A large epidemiological data set was used to identify 115 patients who died from a cardiovascular cause within 30 days of elective surgery under general anaesthesia. For each patient, a control was identified, matched for age (within 5 yr of the patient), sex, operation and consultant. Patients and controls were compared for cardiovascular risk factors in a matched analysis using conditional logistic regression, and a prognostic model was generated. Three risk factors were included in the final model: previous myocardial infarction (odds ratio 3.18 (95% confidence intervals (CI) 1.22-8.28), P = 0.018), history of hypertension (odds ratio 1.90 (0.99-3.62), P = 0.047) and renal failure (odds ratio 3.56 (1.04-12.10), P = 0.043).

P. Foëx

Papers

Studies of anaesthesia in relation to hypertension i: cardiovascular responses of treated and untreated patients

Studies of anaesthesia in relation to hypertension v: adrenergic beta-receptor blockade

Coronary artery stents and non-cardiac surgery

Postoperative myocardial ischaemia: temporal association with nocturnal hypoxaemia

Risk factors for cardiovascular death after elective surgery under general anaesthesia.