Perioperative and Intraoperative Management of Patients with Ischemic Heart Disease Undergoing Noncardiac Surgery: A Comprehensive Evidence-Based Review

Abstract

Patients with ischemic heart disease (IHD) undergoing noncardiac surgery face a heightened risk of major adverse cardiac events (MACE), including myocardial infarction (MI), arrhythmias, and cardiac death. This review synthesizes the latest guidelines from the European Society of Cardiology (ESC 2022), American Heart Association/American College of Cardiology (AHA/ACC 2024), European Society of Anaesthesiology and Intensive Care (ESAIC), and American Society of Anesthesiologists (ASA), along with updated evidence from UpToDate and PubMed. Key focus areas include preoperative risk stratification, intraoperative anesthetic management (medication selection, hemodynamic optimization, ventilation strategies), and postoperative monitoring. Emphasis is placed on inhaled vs. intravenous anesthesia, induction techniques, and hypotension management to minimize perioperative cardiac complications.

Keywords: Ischemic heart disease, noncardiac surgery, perioperative management, anesthesia, hemodynamics, guidelines