Peri op death
Low risk 0 markers 0.3%
Intermediate risk 1-2 markers 2.2%
Hih risk 3 markers. 8.5%
Cardiac risk
Cad CHF CVA Iddm Rf High risk surgery
Higher the functional status lower the risk
Aortic highest risk
Carotid middle
Eye lowest
Look for
USA Decompensated chf Arrhythmias Severe valve disease Symptomatic as risk 10%
Stenotic valves do poorly with anesthesia
Do not cross clamp the aorta on AI patient
Causes of periop events
Catecholamine surges Pro coagulatory state Blood loss Volume shift Plaque rupture Fixed lesions
High risk patients
Use beta blockers
Don’t use in every one(poise study)
Use statin
People who need tgem
Asa
Will help in select patients
Pci
POBA 14 days
BMS. 1-3 Mos
DES. 12 mos