Preoperative assessment for cardiac surgery

Patients presenting for cardiac surgery pose many challenges for the anaesthetist. The clinician has to manage both the presenting cardiac pathophysiology and, increasingly, significant co-morbid disease. Thorough preoperative assessment, investigation and preparation allow identification of those patients at higher risk of perioperative complications, and permits development of individualized care plans in order to minimize these risks. Assessment should be based on a focused anaesthetic history and examination, as well as analysis of cardiovascular investigations, including simple blood tests and complex investigations of cardiac anatomy and function. Scoring systems incorporating biomarkers are often employed as a means of risk stratification and can be used not only to aid perioperative planning and informed consent, but also as an audit and quality improvement tool.This article describes a structured approach to anaesthetic pre-assessment for patients undergoing cardiac surgery. Commonly used preoperative scoring systems are introduced, and the application and interpretation of commonly employed cardiac investigations are summarized.