Population: Asymptomatic adults without cardiac history.

Organization

ESC 2022

Recommendations

Preoperative Evaluation

–Do not obtain routine ECG in asymptomatic patients undergoing low-risk¹ surgical procedures.

–Consider ECG in patients with known coronary heart disease, significant arrhythmia, peripheral arterial disease, or other structural heart disease or are >65-y-old.

–Do NOT routinely perform chest X-rays preoperatively.

–Do NOT routinely test for hemoglobin in healthy, asymptomatic patients. Consider in patients with history of anemia or with prior anticoagulation.

–If known or suspected sleep apnea, communicate with the surgical and anesthesia teams.

–Initiate smoking cessation before elective surgery.

–Delay elective noncardiac surgery at least 60 d after myocardial infarction unless coronary intervention.

Perioperative Medications

–If patients have been on beta-blockers, continue, but do not start on the day of surgery to reduce perioperative risk.

–Hold ACEi and ARBs the morning of the surgery (risk for intraoperative hypotension morbidity). No specific recommendation recording calcium channel blockers or diuretic therapies.

–Do not start alpha-2-agonists to prevent cardiac events in noncardiac surgery.

–Continue statins perioperatively.

–If patients require urgent noncardiac surgery in the 4–6 wk after bare metal or drug-eluting stent, continue dual antiplatelets unless relative risk of bleeding exceeds benefit of preventing stent thrombosis.

–If patients on dual antiplatelets for coronary stents require the P2Y12 platelet receptor-inhibitor to be stopped, continue the aspirin if possible and restart the P2Y12 receptor-inhibitor as soon as possible.

Sources

–http://www.choosingwisely.org/societies/american-college-of-cardiology/

–https://www.icsi.org/guideline/perioperative-guideline/