Critical Care Medicine

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Critical Care Medicine:
doi: 10.1097/01.CCM.0000231885.74567.4F
Scientific Reviews

Vascular surgery critical care: Perioperative cardiac optimization to improve survival

Venkataraman, Ramesh MD

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Objective: To review the literature on perioperative cardiac management of patients who are scheduled to undergo vascular surgery.

Data Source: MEDLINE- and PubMed-based review of literature published from 1965 to 2005.

Conclusions: Perioperative cardiac events (myocardial infarction, heart failure) remain the leading cause of morbidity and mortality in vascular surgery patients. Existing guidelines allow physicians to cost-effectively streamline preoperative cardiac risk assessment and stratification. Perioperative optimization of volume status and cardiac function and the routine use of perioperative beta-blockers can significantly improve outcomes after major vascular surgery. Perioperative addition of statins to beta-blockers in high-risk patients undergoing vascular surgery merits further evaluation. Preoperative coronary revascularization should be restricted to patients with unstable cardiac symptoms.

© 2006 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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