General cardiology ANAESTHESIA AND THE CARDIAC PATIENT: THE PATIENT VERSUS THE PROCEDURE

For patients undergoing elective surgery, the most common cause of significant morbidity andmortality is occurrence of complications related to cardiac disease.1 It is estimated thatapproximately one million patients undergoing surgery each year in the USA suffer a perioperative myocardial infarction.1 This is particularly true for those with previous coronary disease and those facing higher risk surgery. Because of this fact, a great deal of research has focused on assessing cardiac risk before elective surgery. Less attention has been paid to methods of modifying the risk of cardiac complications attending surgery through medication use or other strategies. The risk of cardiac complications engenders a sense of conflict in that the patient per-ceives surgery as a threatening foe to be overcome: the patient versus the procedure.We would like to change that paradigm, and encourage an appreciation for the risk inherent to the patient, rather than to the procedure itself. That is, preoperative evaluation of the patient’s risk, versus the procedure’s risk. During the past 10–20 years, the assessment of cardiac risk before surgery evolved a great deal. Initially, the focus was on appropriate identification of surgical procedures that carried high risk. The focus then shifted to identifying those patient factors associated with increased risk of cardiac complications during surgery. Several technical advances were made during this time, includin