Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942010000600013
Brazilian Journal of Anesthesiology
Review Article

Aspectos relevantes da doença arterial coronariana em candidatos à cirurgia não cardíaca

Relevant aspects of coronary artery disease in candidates for non-cardiac surgery

Gilson Cassem Ramos

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Resumo

JUSTIFICATIVA E OBJETIVOS: Devido à sua prevalência, a doença arterial coronariana (DAC) constitui a principal causa de morbimortalidade em cirurgias eletivas, o que justifica a presente revisão, cujo objetivo foi principalmente estabelecer condutas pré-operatórias baseadas em normas e diretrizes para minimizar a morbimortalidade peri e pós-operatória dos portadores de DAC. CONTEÚDO: São apresentadas características gerais da DAC, assim como seus mecanismos fisiopatogênicos, as principais variáveis relacionadas ao preparo pré-operatório de pacientes com DAC, bem como condutas frente aos enfermos de maior risco cirúrgico. CONCLUSÕES: Portadores de DAC candidatos à cirurgia não cardíaca devem ser rigorosamente avaliados. Os identificados como de alto risco podem beneficiar-se com testes pré-operatórios provocativos de isquemia miocárdica, assim como de intervenções coronarianas invasivas, precedendo operações cirúrgicas eletivas. Em pacientes selecionados, deve-se considerar o uso de betabloqueador e de estatinas .

Palavras-chave

AVALIAÇÃO PRÉ-OPERATÓRIA, CIRURGIA, FATORES DE RISCO

Abstract

BACKGROUND AND OBJECTIVES: Due to its prevalence, coronary artery disease (CAD) represents the main cause of morbidity and mortality in elective surgeries, which justifies this review, whose objective was to establish preoperative conducts based on rules and directive to minimize peri- and postoperative morbidity and mortality of patients with CAD. CONTENTS: General characteristics of CAD, as well as its physiopathogenic mechanisms, the main variables related to preoperative care of patients with CAD, and the conducts for patients with greater surgical risk are presented. CONCLUSIONS: Patients with CAD who are candidates for non-cardiac surgeries should be evaluated judiciously. Those identified as being at high risk can benefit from preoperative myocardial ischemia-provoking tests, as well as from invasive coronary interventions preceding elective surgeries. In selected patients, one should consider the use of beta-blockers and statins.

Keywords

PREOPERATIVE EVALUATION, RISK FACTORS, SURGERY

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