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1 - The role of cardiopulmonary exercise testing in preoperative evaluation of surgical patients

Published online by Cambridge University Press:  15 December 2009

By
Paul Older  and
Adrian Hall
Edited by
Jeremy Cashman  and
Michael Grounds
Paul Older
Affiliation:
Cardiopulmonary Exercise Testing Unit Division of Anaesthesia and Intensive Care Western Hospital Melbourne VIC 3011Australia
Adrian Hall
Affiliation:
Peter MacCallum Cancer Centre East Melbourne VIC 8006 Australia
Jeremy Cashman
Affiliation:
St George's Hospital, London
Michael Grounds
Affiliation:
St George's Hospital, London
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Summary

The situation is, therefore, that the internist believes he can diagnose heart disease in life but can only state in a general way the patient's chance under operation; while the surgeon may deny this ability to discover heart disease while the patient is alive, but confidently makes such a diagnosis if the patient dies.

H. B. Sprague, 1929

If this has a familiar ring then you should read on. Whilst this statement was made in 1929, the modern translation would still represent the feelings of many people today. One group would believe the first part and one group the second part. The true sceptic would of course believe both.

By virtue of the fact that the anaesthesia literature contains numerous articles discussing the best approach for preoperative assessment of major non-cardiac surgery with many urging caution and a rethink of the problem, it is clear that the problem has not yet been solved! For example, some authors strongly recommend perioperative beta-blockade and others are not so sure. A recent systematic review, with meta-analyses, goes further and concludes that there is insufficient evidence to recommend perioperative beta-blockade in any type of surgery for the prevention of death, myocardial infarction or stroke. How can there be such diversity of opinion with no resolution of such a common and serious problem? We believe that the reason for this is that too much attention has been focused on myocardial ischaemia as a risk factor.

Type
Chapter
Information
Recent Advances in Anaesthesia and Intensive Care , pp. 1 - 20
Publisher: Cambridge University Press
Print publication year: 2007

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