Challenging cases: Implications of preoperative electrocardiogram abnormalities

Many preoperative electrocardiogram abnormalities are not clinically significant and must be differentiated from abnormalities prompting further evaluation or action. Anesthesiologists as perioperative practitioners need to recognize abnormalities that are due to other issues – such as lead placement and changes in the respiratory cycle – to prevent unnecessary, costly and potentially harmful further workup. This manuscript details our updated educational framework on this topic incorporating this additional information based on the available evidence for management of preoperative electrocardiogram abnormalities. This will serve as a practical guideline that applies across the perioperative space and can add to the delivery of high-quality, cost-effective care.