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The Beta Blocker and Clonidine Protocol

Lesson 3
Risk Stratification

26. Good Anesthesia

So what are we left with? History & physical with specific attention to unstable angina, myocardial infarction, coronary artery disease, peripheral vascular disease, congestive heart failure, diabetes mellitus, hyperlipidemia, hypertension, smoking, and age. That is not sexy, that is just a plain old dull inexpensive H&P. Well, and good anesthesia. How often have you been told "Avoid hypoxia and/or hypotension" Gee, is one ok without the other? Which should I avoid? Hypoxia? Hypotension? Do any of you wake up and say, The guy is low risk, I am going to give crappy anesthesia today? You do not need any preoperative testing to make the decision to give good anesthesia. You can make that decision for free. Should I worry more? Well, I can worry more for free as well. Worrying more does not require special testing. I want you to give good anesthesia and I am going to redefine good anesthesia as all the normal stuff plus avoiding myocardial ischemia.

What are we left with?

bullet History and physical exam
bullet UA, MI, CAD, PVD, CHF, DM, Chol, HTN, Cig, Age
bullet Good anesthesia?
bullet Who wants to give bad anesthesia?
bullet Avoid hypoxia and/or hypotension ?
bullet Worry more?

Avoid Myocardial Ischemia

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Content by Art Wallace MD PhD
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