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)

Renal insufficiency


Advanced age

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 [7].

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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