The diagnosis and perioperative management of myocardial ischaemia.

CONCLUSION: Perioperative myocardial ischaemia is common in patients who have or are at risk of coronary artery disease, occurring frequently in the pre-, intra- and postoperative periods. The majority of perioperative ischaemic episodes are silent, being unaccompanied by any symptoms of angina. The use of appropriate preoperative laboratory investigations may help in the diagnosis of CAD and the prediction of risk of adverse cardiac outcome. A properly placed and properly calibrated ECG is the best overall monitor of ischaemia. Maintenance of haemodynamic stability is important to reduce the incidence of myocardial ischemia, but ischaemia may occur in the absence of adverse haemodynamic changes. Although our efforts have largely been devoted to the prevention and treatment of intraoperative ischaemia, it is hoped that similar efforts outside the operating room in the postoperative period will further improve patient care and outcome.