Präoperatives Vorgehen bei elektiven, nicht-kardiochirurgischen Eingriffen – Erweiterte Maßnahmen bei kardialen Risikopatienten

Bei Patienten mit bekannten oder vermuteten kardiovaskulären Erkrankungen kann präoperativ eine differenzierte kardiologische Abklärung erforderlich sein. Diese sollte in ausreichendem Abstand zum operativen Eingriff erfolgen, wobei pharmakologische und interventionelle Aspekte, ebenso wie ggf. durchzuführende Prüfungen bzw. Umprogrammierungen therapeutischer Implantate (Herzschrittmacher/Implantierbare Cardioverter Defibrillatoren – ICD) berücksichtigt und ggf. koordiniert werden sollten. Die Entscheidung für oder gegen eine erweiterte präoperative Diagnostik basiert auf 4 Faktoren: dem Vorliegen einer akut symptomatischen Herzerkrankung, dem Vorliegen kardialer Risikofaktoren beim Patienten, der Belastbarkeit des Patienten und dem kardialen Risiko des operativen Eingriffs. Durch transparente und verbindliche interdisziplinäre Absprachen soll damit bei kardialen Risikopatienten eine hohe Patientenorientierung unter Vermeidung unnötiger Voruntersuchungen gewährleistet, präoperative Untersuchungsabläufe verkürzt, sowie letztlich Kosten reduziert werden.

Preoperative differentiated cardiac clarification may be necessary in case of patients suffering from known or suspected cardiovascular diseases. Such clarification should be effected well before surgery. This preparatory investigation should include pharmacological and interventional aspects as well as any necessary examinations or re-programming of therapeutic implants such as pacemakers or implantable cardiovert defibrillators (ICD) or if necessary co-ordination. Decision for or against extended preoperative diagnosis depends on four factors: presence of an acute symptomatic cardiac disease, presence of cardiac risk factors in the patient, the patient's capacity to cope with stress factors and the cardiac risk of surgery. By means of transparent and definite interdisciplinary agreement it should be possible to arrive at a mutual consent on the situation of cardiac risk patients while avoiding unnecessary preoperative examinations. This shortens preoperative procedures and finally also cuts down the overall cost.

Preoperative evaluation - cardiovascular diseases - risk patients - cardiac risk - extended diagnostics

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