Perioperative management of the high-risk surgical patient

Answers to multiple choice questions 1. C, D, E Lee’s risk factors are ischaemic heart disease, heart failure, cerebrovascular disease, diabetes and renal impairment. In general, if a patient is undergoing low-risk surgery or has an exercise tolerance of greater than four METS or has none of the previously mentioned risk factors, then surgery can proceed without further cardiac interventions. Patients outwith these criteria should be considered for initiation of beta blocker therapy prior to surgery and, if it would change management, invasive cardiac stress testing. These decisions should be discussed with an anaesthestist or cardiologist with an interest in preoperative care.