Perioperatives Management von älteren Patienten mit koronarer Herzkrankheit
Perioperative management in the elderly with coronary artery disease The elderly are an ever-increasing patient population presenting for major surgery as a result of demographic development and progressions in perioperative medicine. In addition to the risk factor of their age, they also suffer from co-morbidities that influence their overall perioperative risk. This is especially true for the risk of coronary artery disease, which is frequently found in the elderly and plays an important role
... s an important role in determining perioperative morbidity and mortality. The same guidelines are valid for either routine or preoperative cardiovascular evaluation or therapy. An interdisciplinary approach involving general practitioner, surgeon, anaesthetist, cardiologist and intensivist is crucial for successful perioperative management of these patients. An adequate anti-ischaemic drug therapy including a b-blocker and a statin as well as an adapted anti-thrombotic therapy are important. The indication for preoperative percutaneous coronary intervention with stenting has to be chosen wisely and cautiously because of the elevated risk of mortality of up to 6 months after stenting. Perioperative myocardial infarction is often painless and without typical ST-segment alterations, but has a high mortality and diminishes long-term survival. In this setting, troponine is important both as a diagnostic tool and for prognosis.