Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942001000600010
Brazilian Journal of Anesthesiology
Review Article

Avaliação e preparo pré-operatório do portador de doença das artérias coronárias

Preoperative assessment and preparation of coronary artery disease patients for surgery

Gilson Ramos; José Ramos Filho; Edísio Pereira

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Resumo

JUSTIFICATIVA E OBJETIVOS: Portadores de doença arterial coronária (DAC) apresentam maior morbi-mortalidade peri-operatória em cirurgias não-cardíacas. Exames laboratoriais específicos são aliados importantes do exame clínico e devem ser incluídos no arsenal propedêutico para avaliação e preparo desses pacientes. O objetivo da presente revisão é estabelecer condutas pré-operatórias para minimizar a morbi-mortalidade peri e pós-operatória dos portadores de DAC. CONTEÚDO: São apresentadas características das anginas de peito estável e instável, critérios de classificação clínica e funcional, diagnóstico, terapêutica clínica-cirúrgica e os principais testes laboratoriais cardiológicos disponíveis. Além disso são correlacionados o tipo de angina com o procedimento cirúrgico para proposta de um algoritmo pré-operatório. CONCLUSÕES: Todos os portadores de DAC candidatos à cirurgia não-cardíaca devem ser rigorosamente avaliados. Os identificados como de alto risco necessitam eficaz controle clínico. Nos candidatos clinicamente estáveis, considerados de risco intermediário, testes funcionais não-invasivos são recomendáveis. Em todos os coronariopatas o uso de b-bloqueador deve ser considerado.

Palavras-chave

AVALIAÇÃO PRÉ-ANESTÉSICA; DOENÇA, Cardíaca

Abstract

Background and Objectives: Coronary artery disease (CAD) patients are at greater perioperative morbidity and mortality risk during non-cardiac surgery. Specific laboratory tests are important adjuncts to clinical tests and should be one of the tools for evaluating and preparing those patients. This review aims at establishing preoperative procedures to minimize peri and postoperative morbidity and mortality in CAD patients. Contents: Characteristics of stable and unstable chest anginas are presented, along with clinical and functional classification criteria, diagnosis, clinical-surgical therapy and major cardiologic laboratory tests. In addition, types of angina are correlated to clinical procedures in order to propose a preoperative algorithm. Conclusions: All CAD patients being considered for non-cardiac surgery should be carefully evaluated. Patients at high-risk require effective clinical control. For clinically stable patients, in the intermediate-risk group, functional non-invasive tests are recommended. The use of beta-blockers should be considered for all coronary patients.

Keywords

DISEASE, Cardiac, PREANESTHETIC EVALUATION

References

Mangano DT. Perioperative cardiac morbidity. Anesthesiology. 1990;72:153-184.

Mangano DT, Wong MG, London MJ. Undergoing noncardiac surgery: incidence and severity during the first week after surgery. J Am Coll Cardiol. 1991;17:851-857.

Lee TH, Marcantonio ER, Mangione CM. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;1001:1043-1049.

Quyyumi AA, Mockus L, Wright C. Morphology of ambulatory ST-segment changes in patients with varying severity of coronary artery disease: Investigation of the frequency of nocturnal ischaemia and coronary spasm. Br Heart J. 1985;53:186-193.

Goldman L, Hashimoto B, Cook EF. Comparative reproducibility and validity of systems for assessing cardiovascular functional class: advantages of a new specific activity scale. Circulation. 1981;64:1227-1234.

Meyer K, Westbrook S, Schwaibold M. Aerobic capacity and functional classification of patients with severe left-ventricular dysfunction. Cardiology. 1996;87:443-449.

Eagle KA. Surgical patients with heart disease: summary of the ACC/AHA guidelines. Am Fam Physician. 1997;56:811-818.

Eagle KA, Brundage BH, Chaitman BR. Guidelines for perioperative cardiovascular evaluation for noncardiac surgery: Report of the ACC/AHA Task Force on practice guidelines (Committee on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). J Am Coll Cardiol. 1996;27:910-948.

Scanlon PJ, Faxon DP, Audet AM. Guidelines for coronary angiography: A report of the ACC/AHA task force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and intervention. J Am Coll Cardiol. 1999;33:1756-1824.

Weiner D, Ryan TJ, McCabe CH. Prognostic importance of a clinical profile and exercise test in medically treated patients with coronary artery disease. J Am Coll Cardiol. 1984;3:772-779.

Ellis SG, Vandormael MG, Cowley MJ. Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary artery disease. Circulation. 1990;82:1193-1202.

Wirthlin DJ, Cambria RP. Surgery-specific considerations in the cardiac patient undergoing non-cardiac surgery. Prog Cardiovasc Dis. 1998;40:453-468.

Foster ED, Davis KB, Carpenter JA. Risk of noncardiac operation in patients with defined coronary disease: the Coronary Artery Surgery Study (CASS) registry experience. Ann Thorac Surg. 1986;41:42-50.

Batlouni M. Cirurgia não-cardíaca no paciente cardiopata. Arq Bras Cardiol. 1982;38:475-482.

Mangano DT, Layug EL, Wallace A. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery: Multicenter study of perioperative ischemia research group. N Engl J Med. 1996;335:1713-1720.

Reeder GS, Seward JB, Tajik AJ. The role of two dimensional echocardiography in coronary artery disease. Mayo Clin Proc. 1982;57:247-258.

Hammermeister KE, DeRouen TA, Dodge HT. Variables predictive of survival in patients with coronary disease: Selection by univariate and multivariate analyses from the clinical, electrocardiographic, exercise, arteriographic, and quantitative angiographic evaluations. Circulation. 1979;59:421-430.

White HD, Norris RM, Brown MA. Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation. 1987;76:44-51.

Detrano R, Gianrossi R, Mulvihill D. Exercise-induced ST segment depression in the diagnosis of multivessel coronary disease: a meta-analysis. J Am Coll Cardiol. 1989;14:1501-1508.

Jaarsama W, Visser CA, Funke KAJ. Usefulness of two dimensional exercise echocardiography shorly after myocardial infarction. Am J Cardiol. 1986;57:86-90.

Berthe C, Pierard LA, Hiernaux M. Predicting the extent and location of coronary artery disease in acute myocardial infarction by echocardiography during dobutamine infusion. Am J Cardiol. 1986;58:1167-1172.

Kamp O, de Cock CC, Funke KAJ. Simultaneous transesophageal two-dimensional echocardiography and atrial pacing for detecting coronary artery disease. Am J Cardiol. 1992;69:1412-1416.

Poldermans D, Fioretti PM, Forster T. Dobutamine stress echocardiography for assessment of perioperative risk in patients undergoing major vascular surgery. Circulation. 1993;87:1506-1512.

Boucher CA, Brewster DC, Darling RC. Determination of cardiac risk by dipyridamole-thalium imaging before peripheral vascular surgery. N Engl J Med. 1985;312:389-394.

Froelicher VF, Yanowitz FG, Thompson AJ. The correlation of coronary angiography and the electrocardiographic response to maximal treadmill testing in 76 asymptomatic men. Circulation. 1973;48:597-604.

Ramos J F, Turina M, Ramires JA. Demonstration of Coronary Flow Reserve Before and After Angioplasty and Bypass Surgery by Transesophageal Doppler Echocardiography Method. Universitätsspital Zürich. 1999;45:17-42.

Tsutsui JM, Helaehil SM, Correa MC. Evaluation of coronary blood flow reserve by transesophageal Doppler echocardiography in normal subjects. 1997.

Van Daele ME, Sutherland GR, Mitchell MM. Do changes in pulmonary capillary wedge pressure adequately reflect myocardial ischemia during anesthesia: A correlative preoperative hemodynamic, electrocardiographic, and transesophageal echocardiographic study. Circulation. 1990;81:865-871.

Battler A, Froelicher VF, Gallagher KP. Dissociation between regional myocardial dysfunction and ECG changes during ischemia in the conscious dog. Circulation. 1980;62:735-744.

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