Optimal perioperative medical management of the vascular surgery patient

Anesthesiol Clin. 2014 Sep;32(3):615-37. doi: 10.1016/j.anclin.2014.05.007. Epub 2014 Jun 25.

Abstract

Perioperative medical management of patients undergoing vascular surgery can be challenging because they represent the surgical population at highest risk. β-Blockers should be continued perioperatively in patients already taking them preoperatively. Statins may be used in the perioperative period in patients who are not on statin therapy preoperatively. Institutional guidelines should be used to guide insulin replacement. Recent research suggests that measurement of troponins may provide some risk stratification in clinically stable patients following vascular surgery. Multimodal pain therapy including nonopioid strategies is necessary to improve the efficacy of pain relief and decrease the risk of side effects and complications.

Keywords: Abdominal aortic aneurysm; Anesthesia; Carotid stenosis; Cerebral hyperperfusion; Glucose control; Troponin leak; Vascular surgery; β-blocker.

Publication types

  • Review

MeSH terms

  • Anesthesia / adverse effects
  • Anesthesia / methods
  • Blood Glucose / metabolism
  • Endarterectomy, Carotid / adverse effects
  • Endarterectomy, Carotid / methods
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Perioperative Care / methods*
  • Postoperative Complications / prevention & control
  • Vascular Diseases / drug therapy*
  • Vascular Diseases / surgery*
  • Vascular Surgical Procedures / adverse effects
  • Vascular Surgical Procedures / methods*

Substances

  • Blood Glucose
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors