Gestion préopératoire des médicaments cardiovasculaires

Adequate pre- and postoperative management of cardiovascular treatments plays a pivotal role in reducing cardiac risk of non-cardiac surgery. Beta-blockers improve myocardial oxygenation during the operative period. However, they may worsen postoperative outcome in case of circulatory disturbances, anemia and sepsis. The renin angiotensin system (RAS) plays a pivotal role in maintaining intraoperative blood pressure. Consequently, RAS antagonists increase the lowering blood pressure effect of anesthesia, and may lead to refractory hypotension, which compromises organ perfusion pressure increasing postoperative mortality and morbidity. This is why it is not recommended to continue blockers of the RAS up to the day of surgery. A temporary withdrawal is not associated with a rebound phenomenon. In patients with severe left ventricular dysfunction, RAS antagonists may be continued to improve regional circulations at the expense of blood pressure stability. In that case, a special attention must be paid to maintain the polemic status of the patients and to control blood pressure throughout the perioperative period. Statins are effective to limit the incidence of postoperative myocardial injury. More importantly, they decrease by 50 % postoperative mortality and improve long-termed outcome. Their beneficial effects on postoperative outcome are all the more effective in case of postoperative medical or surgical complication.