ESC-Leitlinie 2022 – Kardiovaskuläre Abklärung und Management von Patienten mit nicht kardialen chirurgischen Eingriffen – Eine fallorientierte Zusammenfassung einiger der wichtigsten Neuerungen

Was ist neu?

Risikostratifizierung und präoperative Evaluation Die wesentlichen Neuerungen ergeben sich aus der Möglichkeit einer sehr individuellen Risikostratifizierung von Patienten, die sich nicht kardialen chirurgischen Eingriffen unterziehen, die sich aus einer patienten- sowie eingriffsorientierten Risikoeinteilung zusammensetzt.

Perioperative Anpassung der medikamentösen Therapie Auch die klaren und zugleich individualisierbaren Handlungsempfehlungen hinsichtlich des perioperativen Managements gerinnungshemmender Therapien resultieren in unmittelbarer klinischer Relevanz.

Perioperativer Myokardschaden (PMI) Ferner stellt die Aufwertung kardialer Biomarker sowohl im Rahmen der präoperativen Risikostratifizierung als auch der frühzeitigen Erkennung peri- und postoperativer (ischämischer) Myokardschädigungen eine relevante Neuerung mit unmittelbarem klinischen Bezug dar.

Abstract

In August 2022, the European Society of Cardiology (ESC) published new guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. In order to cope with the complexity of the patients and the multidisciplinary, representatives of the European Society of Anesthesia and Intensive Care Medicine as well as 2 patient representatives were involved in the development of the published document in addition to authors from the European Society of Cardiology. As a result, the document contains 147 recommendations on this complex topic, with more than half of them being grade I recommendations.

The interdisciplinarity and the need for interdisciplinary cooperation in this context is particularly emphasized. Particular attention was also paid to recommendations for action for a structured preoperative risk stratification. The new guidelines also focus on increasing vigilance for perioperative myocardial damage and identifying it at an early stage.

In the following article, some of the essential innovations and revisions will be highlighted using practical clinical case studies.

Schlüsselwörter

Leitlinie - nicht kardiale Chirurgie - Myokardinfarkt - perioperativ

Keywords

guidelines - non cardiac surgery - myocardial infarction - perioperative

Publication History

Article published online:
23 August 2023

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