ABSTRACT
Cardiac events are estimated to account for more than 50% of perioperative deaths. Tachycardia is the most common hemodynamic abnormality associated with ischemia. An increase in heart rate both increases demand and decreases diastolic lling time. An imbalance between myocardial oxygen supply and demand results in ischemia. In general, the risk of a perioperative coronary event following major gynecologic oncology surgeries is approximately 1%–5% [11]. e incidence of myocardial infarction aer noncardiac surgery in patients with ischemic heart disease is as high as 5%–6%, with a peak incidence within 2 days of surgery [12]. Chest pain is not a typical symptom, and electrocardiograms (ECGs) may not show typical Q-wave changes. Although the initiation of perioperative β-adrenergic receptor blockade has previously been recommended to decrease perioperative myocardial infarction and mortality [13,14], more recent
studies have not supported these recommendations [15]. In a randomized controlled trial of 8000 patients undergoing noncardiac surgery, metoprolol therapy reduced the risk of myocardial infarction but actually increased the risk of perioperative death and stroke. ose patients with indications for long-term beta-blocker use, including patients with known cardiac ischemia, may still be considered for initiation of beta-blockade at the discretion of their primary care provider or cardiologist at least 2 weeks prior to surgery [16]. Patients who are taking antihypertensive medications preoperatively should be continued on these drugs in most cases, with careful monitoring of blood pressure and heart rate as aected by perioperative pain and uid management. Treatment with statins has also been associated with improved mortality aer noncardiac surgery but is not a routine recommendation at this time [17].
