Other Surgeries: New Guidelines

• by StarWish624
• 2009-06-26 09:06:18
• General Posting
• 974 views
• 2 comments

I was sent this info. in a newsletter. I thought that you might want to print it out and keep in case you have other health situations, and need to have it. I would show it to your Cardio. Dr., and discuss it. Then show it to your G.P.
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Daily Health News
Safer Surgery for Those with Heart Conditions
Date: Thursday, June 25, 2009, 6:23 AM




Safer Surgery for Those with Heart Conditions

Even every-day activities can be fraught with worry for people with heart disease, so it’s understandable that many feel frightened at the prospect of doing something inherently risky -- like having surgery. Fortunately there is a new set of guidelines that helps patients and physicians determine whether it is safe for people with heart disease to undergo surgery for conditions unrelated to the heart. Where their high-risk status once kept such patients out of the operating room even if a procedure might have solved other health problems, the new rules are more relaxed.
This new advice reflects a joint effort of a panel of experts from the nation's two leading heart groups, the American College of Cardiology and the American Heart Association, who were focused on how to reduce the heart patient's risk of a cardiac event during or immediately after surgery. Lee A. Fleisher, MD, Robert Dunning Dripps Professor and chair of the department of anesthesiology and critical care at the University of Pennsylvania Health System, who is chairman of the expert panel, took me through the revised recommendations.
CARDIOVASCULAR TESTING
AND INTERVENTIONS

For people who have stable heart disease, the revised guidelines no longer require having their heart problems fixed before having non-cardiac surgery. It was previously believed that testing and subsequent interventions (such as opening clogged arteries with angioplasty and stenting or even bypass surgery) improved outcome of the non-cardiac surgery, but new research found otherwise.
Interestingly, Dr. Fleisher told me that for patients with stable heart disease, undergoing angioplasty can actually make the subsequent surgery more dangerous. Heart attack risk rises when anti-clotting medication, such as aspirin or Plavix, is stopped before surgery. However, the new guidelines recommend minimizing how much time a patient is off anti-clotting medication.
It’s important to note, however, that patients with unstable coronary conditions -- such as severe angina, previous heart failure, significant heart rhythm disturbances, or severe heart valve disease -- still need to have advance testing and sometimes interventions beforehand in order to reduce the risks of surgery.
STATINS

Previous guidelines advised patients to stop taking their cholesterol-lowering drugs (statins) before surgery, since these can affect the liver and cause muscle to break down, risks believed to be especially high during and immediately after surgery. Dr. Fleisher says: "We now know you can stop statins for a short time... but not for more than four days, because of the risk of a cardiac event. In fact, a new study shows that starting statins is actually preventive for patients undergoing vascular surgery." However, he added that if a patient needs to begin taking statin drugs, he/she should start at least a week before surgery. Also, notes Daily Health News contributing editor Andrew L. Rubman, ND, natural treatments can be an effective way to reduce the risk of clot formation as well. "People can often use supplements and omega-3 sources like fish oil to accomplish this," he said.
BETA BLOCKERS

The new guidelines say that people who take beta blockers, which are medications commonly used to decrease heart rate and reduce blood pressure, should not change their routine for surgery.
Dr. Fleisher says: "Doctors used to suggest that patients who had never taken beta blockers before should start them the morning of non-cardiac surgery to improve outcome, but there’s now concern about doing that, especially at high doses." A large trial (POISE) showed that while this approach prevented heart attacks, it was associated with an increased risk of stroke and death. Note: Patients should never start a new drug that has risk of significant side effects right before having surgery.
EXCELLENT CARDIAC CARE IS A MUST

Though these new guidelines are less restrictive, it remains important for heart patients to ensure their cardiovascular problems are being closely monitored and are under control. A key component of the new guidelines is that a complete screening history is taken to establish that your heart condition is stable before surgery -- no matter what the procedure is for. You may also want to schedule an advance consult with the anesthesiologist -- check with your doctor to see if this is appropriate in your situation.
Dr. Rubman says it may be well to note that naturopathic interventions both pre- and post-surgery may lessen risks at surgery, improve recovery from anesthesia and hasten healing afterward. This care should be coordinated both with the surgeon and anesthesiologist to provide maximum benefit and avoid complications.
Source(s):

Lee A. Fleisher, MD, Robert Dunning Dripps Professor and chair in the department of anesthesiology and critical care, University of Pennsylvania Health System, Philadelphia.