10
Treatment
Table 5. Anesthetic Consideration and Intraoperative
Management
Recommendations COR LOE
Volatile general anesthesia versus total intravenous anesthesia
Use of either a volatile anesthetic agent or total intravenous
anesthesia is reasonable for patients undergoing noncardiac
surgery, and the choice is determined by factors other than
the prevention of myocardial ischemia and MI.
IIa A
Perioperative pain management
Neuraxial anesthesia for postoperative pain relief can be
effective in patients undergoing abdominal aortic surgery to
decrease the incidence of perioperative MI.
IIa B
Preoperative epidural analgesia may be considered to
decrease the incidence of preoperative cardiac events in
patients with hip fracture.
IIb B
Prophylactic intraoperative nitroglycerin
Prophylactic intravenous nitroglycerin is NOT effective
in reducing myocardial ischemia in patients undergoing
noncardiac surgery.
III: No
Benefit
B
Intraoperative monitoring techniques
Emergency use of perioperative TEE is reasonable in
patients with hemodynamic instability undergoing
noncardiac surgery to determine the cause of hemodynamic
instability when it persists despite attempted corrective
therapy, if expertise is readily available.
IIa C
Routine use of intraoperative TEE during noncardiac
surgery to screen for cardiac abnormalities or to monitor
for myocardial ischemia is NOT recommended in patients
without risk factors or procedural risks for significant
hemodynamic, pulmonary, or neurologic compromise.
III: No
Benefit
C
Maintenance of body temperature
Maintenance of normothermia may be reasonable to
reduce perioperative cardiac events in patients undergoing
noncardiac surgery.
IIb B
Hemodynamic assist devices
Use of hemodynamic assist devices may be considered
when urgent or emergency noncardiac surgery is required
in the setting of acute severe cardiac dysfunction (i.e.,
acute MI, cardiogenic shock) that cannot be corrected
before surgery.
IIb C
