Update in Perioperative Medicine
Authors: Steven L. Cohn, Gerald W. Smetana
Journal: Annals of Internal Medicine (2007)

Updates21 August 2007Update in Perioperative MedicineSteven L. Cohn, MD and Gerald W. Smetana, MD*Steven L. Cohn, MDFrom the State University of New York Downstate Medical Center, Brooklyn, New York, and Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts. and Gerald W. Smetana, MD*From the State University of New York Downstate Medical Center, Brooklyn, New York, and Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-147-4-200708210-00008 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail This year's Update in Perioperative Medicine includes discussions of preoperative revascularization, prevention of cardiac and pulmonary complications, and postoperative delirium. Changes to clinical practice emerging from these articles are shown in the Table . Table. Changes to Clinical Practice Emerging from Articles Important to Perioperative Medical Consultants in 2006Preoperative Revascularization Leibowitz D, Cohen M, Planer D, et al. Comparison of cardiovascular risk of noncardiac surgery following coronary angioplasty with versus without stenting. Am J Cardiol. 2006;97:1188-91. [PMID: 16616024]Question: In patients undergoing noncardiac surgery after percutaneous ...References1. Kałuza GL, Joseph J, Lee JR, Raizner ME, Raizner AE. Catastrophic outcomes of noncardiac surgery soon after coronary stenting. J Am Coll Cardiol. 2000;35:1288-94. [PMID: 10758971] CrossrefMedlineGoogle Scholar2. Wilson SH, Fasseas P, Orford JL, Lennon RJ, Horlocker T, Charnoff NE, et al. Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting. J Am Coll Cardiol. 2003;42:234-40. [PMID: 12875757] CrossrefMedlineGoogle Scholar3. Sharma AK, Ajani AE, Hamwi SM, Maniar P, Lakhani SV, Waksman R, et al. Major noncardiac surgery following coronary stenting: when is it safe to operate? Catheter Cardiovasc Interv. 2004;63:141-5. [PMID: 15390248] CrossrefMedlineGoogle Scholar4. Reddy PR, Vaitkus PT. Risks of noncardiac surgery after coronary stenting. Am J Cardiol. 2005;95:755-7. [PMID: 15757604] CrossrefMedlineGoogle Scholar5. Brilakis ES, Orford JL, Fasseas P, Wilson SH, Melby S, Lennon RJ, et al. Outcome of patients undergoing balloon angioplasty in the two months prior to noncardiac surgery. Am J Cardiol. 2005;96:512-4. [PMID: 16098302] CrossrefMedlineGoogle Scholar6. Grines CL, Bonow RO, Casey DE, Gardner TJ, Lockhart PB, Moliterno DJ, et al. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. J Am Coll Cardiol. 2007;49:734-9. [PMID: 17291948] MedlineGoogle Scholar7. McFalls EO, Ward HB, Moritz TE, Goldman S, Krupski WC, Littooy F, et al. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med. 2004;351:2795-804. [PMID: 15625331] CrossrefMedlineGoogle Scholar8. Juul AB, Wetterslev J, Gluud C, Kofoed-Enevoldsen A, Jensen G, Callesen T, et al. Effect of perioperative beta blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial. BMJ. 2006;332:1482. [PMID: 16793810] CrossrefMedlineGoogle Scholar9. Brady AR, Gibbs JS, Greenhalgh RM, Powell JT, Sydes MR. Perioperative beta-blockade (POBBLE) for patients undergoing infrarenal vascular surgery: results of a randomized double-blind controlled trial. J Vasc Surg. 2005;41:602-9. [PMID: 15874923] CrossrefMedlineGoogle Scholar10. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043-9. [PMID: 10477528] CrossrefMedlineGoogle Scholar11. Mangano DT, Layug EL, Wallace A, Tateo I. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med. 1996;335:1713-20. [PMID: 8929262] CrossrefMedlineGoogle Scholar12. Poldermans D, Boersma E, Bax JJ, Thomson IR, van de Ven LL, Blankensteijn JD, et al. The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med. 1999;341:1789-94. [PMID: 10588963] CrossrefMedlineGoogle Scholar13. Marcantonio ER, Goldman L, Mangione CM, Ludwig LE, Muraca B, Haslauer CM, et al. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA. 1994;271:134-9. [PMID: 8264068] CrossrefMedlineGoogle Scholar14. Inouye SK, Viscoli CM, Horwitz RI, Hurst LD, Tinetti ME. A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Ann Intern Med. 1993;119:474-81. [PMID: 8357112] LinkGoogle Scholar15. Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, et al. ACC/AHA 2006 guideline update on perioperative cardiovascular evaluation for noncardiac surgery. Circulation. 2006;113:2662-74. [PMID: 16754815] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From the State University of New York Downstate Medical Center, Brooklyn, New York, and Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.*Adapted for publication in Annals of Internal Medicine by Jennifer Fisher Wilson and Michael Berkwits, MD, MSCE.Disclosures: Honoraria: S.L. Cohn (Sanofi-Aventis, Pfizer Inc.), G.W. Smetana (Harvard Medical International/Novartis Pharma Schweiz). Stock ownership or options (other than mutual funds): S.L. Cohn (Pfizer Inc., GlaxoSmithKline, Merck & Co. Inc., AstraZeneca), G.W. Smetana (SafeMed Imaging).Corresponding Author: Steven L. Cohn, MD, Division of General Internal Medicine, Department of Medicine, State University of New York Downstate Medical Center, 470 Clarkson Avenue, Box 68, Brooklyn, NY 11203; e-mail, steven.[email protected]edu.Current Author Addresses: Dr. Cohn: Division of General Internal Medicine, Department of Medicine, State University of New York Downstate Medical Center, 470 Clarkson Avenue, Box 68, Brooklyn, NY 11203.Dr. Smetana: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Shapiro 621D, Boston, MA 02215. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByStandard perioperative management in gastrointestinal surgeryPreventing Postoperative Complications in the ElderlyImportance of serum albumin level in the preoperative tests conducted in elderly patients with hip fracturePreoperative Testing and Medication Management 21 August 2007Volume 147, Issue 4Page: 263-270KeywordsCardiac surgeryCohort studiesDeliriumHeart rateMedical risk factorsPercutaneous coronary interventionRevascularizationStatinsSurgeryVascular surgery ePublished: 21 August 2007 Issue Published: 21 August 2007 CopyrightCopyright © 2007 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...