ABSTRACT
INTRODUCTION AND DEFINITIONS More and more frequently, the trend towards invasive management of severe coronary events by cardiologists and towards liberal indications to noncardiac operations by surgeons places the anesthesiologist in front of a difficult situation: how to manage a patient with severe coronary artery disease (CAD) or an acute coronary syndrome (ACS) who requires urgent surgery? In the algorithm for assessing patients with or at risk of CAD presented elsewhere in this book (chap. 7, Fig. 2), this patient will be allotted to the intermediate-risk or to the high-risk group. Most of the time, patients in these groups should be investigated and prepared for surgery, and frequently revascularized. The surgical situations we are dealing with in this chapter are defined by their urgent or vital character, and the delays imposed by such investigations and treatments cannot be tolerated. Therefore, some solution must be found to protect these patients from ischemic complications during the perioperative period. The literature concerning noncardiac surgery for these patients is scarce and consists mostly of nonrandomized series, observational data, or expert opinions. The rationale of the perioperative care for CAD patients with urgent or semiurgent operations is thus largely based on studies from the cardiology domain and extrapolated from the recommendations for their medical treatment. The decisions are the result of the application of the precaution principle rather than being the result of firm scientific evidence.
