Preoperative assessment for cardiac surgery

Preoperative assessment enables anaesthetists to tailor an anaesthetic to an individual patient. Established classification systems give objectivity to a patient's description of his or her effort limitation. Anaesthetists need a working knowledge of the preoperative investigations. They also need to understand risk stratification tools for cardiac surgery to answer questions from patients that relate to the risks of surgery and anaesthesia. Most preoperative medications should be continued until surgery. Antiplatelet therapy should be discontinued 7 days before surgery, if possible. Anaesthetists should explain the likely events in the anaesthetic room, such as the placement of venous and arterial cannulae before preoxygenation and induction of anaesthesia as well as the likely postoperative course on a cardiac intensive care unit. Establishing a rapport with the patient preoperatively and a benzodiazepine anxiolytic are useful adjuncts to anaesthesia.