Cardiac arrhythmias especially atrial fibrillation

Arrhythmias following surgery are common, often exacerbated by the abrupt withdrawal of cardiac drugs due to fasting. They are also caused by hypotension, metabolic derangements, and hypoxaemia - all of which are preventable. It is important that patients with heart disease are maintained on their usual drugs, via alternative routes if possible, during the perioperative period. This particularly applies to p blockers, which should be administered on the day of surgery.

Five per cent patients over the age of 65 have chronic atrial fibrillation (AF) and it is a common preoperative finding. Certain procedures are associated with the development of AF, for example intrathoracic surgery. Patients with chronic lung or cardiac disease are at greater risk of developing postoperative AF. The main difference in the preoperative period is that p- or calcium channel blockers are considered more effective than digoxin in controlling the ventricular rate during stress. If the patient is anticoagulated, this also needs to be addressed in the preoperative period.

Prophylactic cardiac pacing may be required prior to surgery in patients at risk of developing complete heart block. These include patients with bi- or trifascicular block on the ECG, and they should be assessed by a cardiologist.

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