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n CME : Your SA Journal of CPD - Should I anaesthetise this patient? Rational cardiovascular assessment : main article
Cardiovascular disease is a leading cause of perioperative morbidity in South Africa.
Unstable cardiovascular conditions need to be identified preoperatively and further evaluated.
Unstable cardiovascular conditions include unstable coronary syndromes, decompensated cardiac failure, significant arrhythmias and severe valvular heart disease.
Perioperative cardiac morbidity is related to the medical condition and functional capacity of the patient, and the extent of the surgery.
Cardiac clinical risk predictors include a history of ischaemic heart disease, heart failure, stroke, diabetes and renal dysfunction.
Patients undergoing low-risk surgery and patients with good functional capacity are generally good surgical candidates.
One should always first consider the risk versus benefit before deferring an intermediate-risk patient.
Attention to simple perioperative factors such as analgesia, temperature and postoperative oxygen is important.
In high-risk cases anaesthesia must be provided by the most experienced doctor possible within the limitation of the health service.
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