Anaesthesia for cardiac patients having non-cardiac operations.

It is difficult to pick out a sensitive marker for the effectiveness with which patients with heart disease have been managed for non-cardiac operations. Reinfarction rates have frequently been cited for this purpose over the past 20 years and it is interesting and perplexing that, until very recently, we have been unable to show significant decreases in reinfarction rates in patients who have had a myocardial infarction within six months of surgery. It has been our opinion for a number of years that, in general, patients with heart disease are well managed in the intraoperative phase of their hospital stay. The successful management of patients during this period is based on the fact that the majority of anaesthetists now appear to have a good understanding of the pathophysiology of heart disease and are becoming more aggressive in the monitoring and treatment of abnormal haemodynamics when they occur. The ultimate extent to which morbidity and mortality can be reduced in patients with heart disease for non-cardiac surgery will not be known until patients at high risk receive the same intensive postoperative care that patients who undergo heart surgery enjoy. It is the fact that patients are haemodynamically stable and do not have myocardial ischaemia throughout the peri-operative period that is important, rather than the way in which it is achieved.