Anesthetic management and perioperative surveillance

The intraoperative management of the high-risk patient has received a great deal of attention and research during the past decade. Based on the available evidence, there appears to be no one best anesthetic technique or agent. More importantly, the goals of intraoperative management are to avoid myocardial ischemia, which include preventing tachycardia, and maintaining normothermia and adequate hematocrit. Perioperative monitoring includes transesophageal echocardiography, pulmonary artery catheter and ST segment monitoring. Perioperative pharmacological treatment with alpha-2 agonists and beta-adrenergic blocking agents are associated with a reduced incidence of perioperative myocardial ischemia and improved long-term survival, respectively. Future research will be required to determine whether prophylactic therapy or early treatment of perioperative myocardial ischemia will lead to improved outcome.