Minimizing cardiac risk in perioperative practice - interdisciplinary pharmacological approaches

Wien Klin Wochenschr. 2011 Jul;123(13-14):393-407. doi: 10.1007/s00508-011-1595-2. Epub 2011 Jun 22.


Background: In an aging population, major surgery is often performed in patients with complex co-morbidities. These patients present new risk constellations so that cardiac and respiratory complications mainly contribute to perioperative morbidity.

Methods: We composed a narrative review on pharmacological approaches to cardiovascular protection in the perioperative period including effects of central neuraxial blocks and hypothermia on cardiovascular outcome. The single chapters are structured as follows: pathophysiology-early studies-recent evidence-recommendations.

Results: In coping with this challenge, innovative concepts like fast track surgery and pharmacological treatment are being utilized with increasing frequency including perioperative cardioprotection, novel strategies of anticoagulation or antiplatelet therapy, and protocols for postoperative pain therapy.

Conclusion: All the concepts described require an interdisciplinary approach in collaboration between operative physicians and physicians working in non-surgical disciplines like internal medicine, cardiology, and clinical pharmacology. The perioperative continuation of a pre-existing therapy with beta-blockers and other potentially cardioprotective agents like α(2)-agonists and statines is recommended. In the management of patients presenting for major surgery stratification of the perioperative risk is essential which considers both, invasiveness of the surgical procedure and conditions of the patient. Otherwise, side-effects might outweigh benefits of a potentially effective therapy as recently shown for the perioperative administration of beta-blockers that should be restricted to high-risk patients.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cardiovascular Agents / administration & dosage*
  • Cardiovascular Agents / adverse effects
  • Comorbidity
  • Cooperative Behavior*
  • Coronary Thrombosis / mortality
  • Coronary Thrombosis / prevention & control
  • Death, Sudden, Cardiac / prevention & control*
  • Drug Therapy, Combination
  • Evidence-Based Medicine
  • Hospital Mortality
  • Humans
  • Interdisciplinary Communication*
  • Length of Stay
  • Myocardial Infarction / mortality
  • Myocardial Infarction / prevention & control*
  • Perioperative Care / methods*
  • Postoperative Complications / mortality
  • Postoperative Complications / prevention & control*
  • Risk Factors


  • Cardiovascular Agents