Preoperative assessment for cardiac surgery

Patients presenting for cardiac surgery pose several challenges for the anaesthetist. Not only are they preparing for major surgery to improve impaired cardiovascular function, but many also suffer from significant co-morbid disease. Thorough preoperative assessment and investigation is imperative. This allows identification of those patients at high risk of perioperative complications, and promotes development of individualized care plans to minimize these risks. The assessment should combine a focused anaesthetic history and examination with the analysis of all cardiovascular investigations, ranging from simple blood tests to complex investigations of cardiac anatomy and function. Scoring systems are often employed as a means of risk stratification and can be used not only to aid in perioperative planning and informed consent, but also as an audit tool.This article describes the many facets of anaesthetic pre-assessment for patients undergoing cardiac surgery, highlighting several issues common to this group of patients. The concept of preoperative scoring systems is introduced, and the application and interpretation of several commonly employed cardiac investigations summarized.