Cleveland Clinic journal of medicine
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The American College of Cardiology and American Heart Association updated their joint guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery in 2007. The guidelines recommend preoperative cardiac testing only when the results may influence patient management. ⋯ In most instances, coronary revascularization before noncardiac surgery has not been shown to reduce morbidity and mortality, except in patients with left main disease. The timing of surgery following percutaneous coronary intervention (PCI) depends on whether a stent was used, the type of stent, and the antiplatelet regimen.
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Perioperative fluid management remains controversial. Nevertheless, its optimization is essential to reducing the risk of postoperative complications, which have been shown to profoundly affect patients' short- and long-term outcomes. ⋯ The optimal fluid is controversial, although colloids appear to have some physiologic advantages over crystalloids. Minimally invasive technologies have emerged for intraoperative monitoring of blood flow, which may enable more precise fluid titration.