GREAT LAKES HEART CENTER OF ALPENA

• should be continued in patients undergoing surgery who are receiving beta blockers
• patients undergoing vascular surgery who are at high cardiac risk owing to the finding of ischemia on preoperative testing.
• patients undergoing vascular or intermediate - risk surgery in whom preoperative assessment identifies CAD (Class II).
• patients undergoing vascular or intermediate - risk surgery who are at high cardiac risk, defined by the presence of more than 1 clinical riskfactor (Class II).
• the usefulness of beta blockers is uncertain in patients undergoing intermediate-risk or vascular surgery, in whom one clinical risk factor is present (Class II).
• the usefulness of beta blockers is uncertain in patients undergoing vascular surgery with no clinical risk factors and who are not currently on beta blockers (Class II).

• statins should be continued in patients currently taking the drug and scheduled for noncardiac surgery.
• statin use is reasonable in patients undergoing vascular surgery (Class II).
• statins may be considered in patients with at least 1 clinical risk factor scheduled yo undergo intermediate-risk procedures (Class II).

• The usefulness of nitrates to prevent myocardial ischemia and cardiac morbidity during surgery is unclear, particularly for patients who have required nitrate therapy to control angina.
• Nitrates may actually lead to cardiovascular decompensationby decreasing preload.
• Topical nitroglycerin may have uneven absorption intraoperatively, so when clinically indicated, administer nitroglycerin intravenously.
• The venodilating and arterial dilating effects of nitroglycerin are mimicked by some anesthetic agents, so that the combination of agents can cause hypotension and myocardial ischemia.

Therefore, nitroglycerin should be used only when the hemodynamic effects of other agents being used and intravascular volume status have been considered.