Medically Optimizing the Cardiac Surgical Patient

Abstract

Perioperative medicine is a discipline that plays an increasing role in reducing perioperative morbidity and mortality for patients with complex medical conditions. Given the chronic nature of many medical conditions, medical optimization is critical in achieving patients’ stability prior to elective surgery. This chapter highlights the integral parts of perioperative medical optimization: management of comorbid conditions, management of medications, and institution of preventative measures to reduce complications, e.g., smoking cessation. Internists are commonly engaged in managing hypertension, ischemic heart disease, congestive heart failure, atrial fibrillation, diabetes, chronic obstructive pulmonary disease, obstructive sleep apnea, and other chronic and complex conditions. Recognizing warning signs associated with such conditions that require postponement of elective operations and taking measures to reduce perioperative complications and mortality are important goals. Managing complex medication regimens in the perioperative period requires careful planning and must be tailored to the patient and the type of surgery. By the end of this chapter, the reader should be able to identify such critical components of perioperative medicine.

As to diseases, make a habit of two things — to help, or at least, to do no harm.

—Hippocrates