The objectives of premedication are to prepare the patient for anaesthesia and to help provide good conditions for surgery. In practice this involves a combination of the following:
• reduction of anxiety and pain;
• facilitation of intravenous (i.v.) access;
Table 2.6. Clinical Indicators of increased perioperative clinical cardiovascular risk (myocardial infarction, heart failure, death).
• Unstable coronary syndromes
- Acute or recent myocardial infarction with evidence of important ischaemic risk by clinical symptoms of non-invasive study
- Unstable or severe angina (Canadian class III or IV)
• Decompensated heart failure
• Significant arrhythmias
- High-grade aventricular block
- Symptomatic aventricular arrhythmias in the presence of underlying heart disease
- Supraventricular arrhythmias with uncontrolled ventricular rate
• Severe valvular disease Intermediate
Mild angina pectoris (Canadian Class I or II)
Previous myocardial infarction history by pathologic Q waves
Compensated or prior heart failure
Diabetes mellitus (particularly insulin dependent)
Abnormal ECG (left ventricular hypertrophy, left bundle-branch block, ST-T abnormalities) Rhythm other than sinus (e.g. atrial fibrillation) Low functional capacity (e.g. unable to climb a flight of stairs with a bag of vegetables) History of stroke
Uncontrolled systemic hypertension
AHA guidelines .
Table 2.7. Risk of reinfarction following anaesthesia; relationship to previous myocardial infarction.
Interval between previous myocardial infarction and surgery (months)
Incidence of perioperative myocardial infarction (%)
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