Medical therapy to reduce perioperative cardiac complications.

Preoperative cardiac assessment has become an integral part of contemporary anesthesia practice. Simple clinical markers can identify high-risk patients, but the question of how to reduce cardiac complications among high-risk patients has been controversial. Good quality randomized controlled trials have showed that neither preoperative coronary revascularization nor the placement of pulmonary artery catheters reduces perioperative cardiac complications. On the other hand, there is increasing evidence that medical therapy offers myocardial protection and reduces perioperative cardiac complications. The data supporting these conclusions are reviewed in an evidence-based manner. At present, it is prudent to treat moderate- to high-risk patients undergoing elective surgery with beta-blockers if possible. Because not all patients are candidates for beta-blocker therapy, data regarding the perioperative use of alternative medications to reduce perioperative cardiac complications have been explored and are reviewed.