ESC GUIDELINE FOR NON CARDIAC SURGERY.pptx

guideline untuk mengevaluasi resiko penyakit jantung pada rencana operasi selain jantung

1. 2020 ESC GUIDELINE NON CARDIAC SURGERY Digoxin-2024

2. Introduction

3. Class of Recommendation

4. ESC guideline The objective of this guideline is to endorse a standardized and evidence-based approach to peri-operative CV management. The guidelines recommend a stepwise evaluation of the patient that integrates clinical risk factors and test results with the estimated stress of the planned surgical procedure and the risks involved with the discontinuation of drugs. This results in an individualized risk assessment, with the opportunity of initiating medical therapy, coronary interventions, and specific surgical and anaesthetic techniques, or withholding medical therapy, in order to optimize the patient’s peri-operative condition

5. Clinical Risk Evaluation

6. Surgical-related Risk Cardiovascular morbidity and mortality in patients undergoing NCS are determined by two main factors: patient-related risk and type of surgery or procedure

7. Patient-related Risk

8. Patient-related Risk

9. Patients with symptoms

10. Pre-operative Assessment Tools

11. Risk score

12. Functional capacity

13. Electrocardiography It is recommended to obtain a pre-operative 12-lead ECG in patients who are aged ≥65 years or have known CVD, CV risk factors, or symptoms suggestive of cardiac disorders, and scheduled to undergo intermediate- or high-risk surgery. It is not recommended to routinely obtain a pre-operative ECG in low-risk patients undergoing low risk NCS. Pre-operative recording of ECG also enables identification of intra- and post-operative ECG changes.

14. Biomarkers High-sensitivity cardiac troponin T/I (Hs-cTn T/I) quantifies myocardial injury, and BNP and NT-proBNP quantify haemodynamic cardiac wall stress

15. Biomarkers High-sensitivity cardiac troponin T/I (Hs-cTn T/I) quantifies myocardial injury, and BNP and NT-proBNP quantify haemodynamic cardiac wall stress

16. Biomarkers

17. Non-invasive and invasive procedures Transthoracic echocardiography

18. Non-invasive and invasive procedures Stress imaging

19. Non-invasive and invasive procedures Angiography

20. General risk-reduction strategies

21. Cardiovascular risk factors and lifestyle interventions

22. Pharmacological Beta-blockers Amiodarone Statins Renin–angiotensin–aldosterone system Inhibitors Calcium channel blockers Alpha-2 receptor agonists Diuretics Ivabradine Sodium–glucose co-transporter-2 inhibitors

23. Pharmacological Beta-blockers Amiodarone Statins Renin–angiotensin–aldosterone system Inhibitors Calcium channel blockers Alpha-2 receptor agonists Diuretics Ivabradine Sodium–glucose co-transporter-2 inhibitors

24. Peri-operative handling of antithrombotic agents Antiplatelets

25. Peri-operative handling of antithrombotic agents Antiplatelets

26. Peri-operative handling of antithrombotic agents Antiplatelets

27. Peri-operative handling of antithrombotic agents Antiplatelets

28. Peri-operative handling of antithrombotic agents Antiplatelets

29. Peri-operative handling of antithrombotic agents Antiplatelets

30. Peri-operative handling of antithrombotic agents Oral antikoagulants

31. Peri-operative handling of antithrombotic agents Oral antikoagulants

32. Peri-operative handling of antithrombotic agents Oral antikoagulants

33. Peri-operative handling of antithrombotic agents Oral antikoagulants

34. Peri-operative thromboprophylaxis

35. Specific Diseases

36. Coronary artery disease

37. Coronary artery disease

38. Chronic Heart Failure

39. Chronic Heart Failure

40. Valvular heart disease

41. Valvular heart disease

42. Valvular heart disease

43. Valvular heart disease

44. Arrhythmias

45. Arrhythmias

46. Adult congenital heart disease

47. Pericardial diseases

48. Pulmonary disease

49. Arterial hypertension

50. Peripheral artery disease

51. Cerebrovascular disease

52. Renal disease

53. Obesity

54. Diabetes

55. Peri-operative Cardiovascular Complications

56. Peri-operative cardiovascular complications

57. Peri-operative myocardial infarction/injury

58. Peri-operative myocardial infarction/injury

59. Atrial fibrillation and other relevant arrhythmias

60. Peri-operative stroke

61. Terimakasih