Résumé
Ce texte destiné aux résidents d’anesthésie-réanimation en début de stage dans un service cardio-vasculaire, discute du risque opératoire et de certains problèmes courants chez les patients devant subir une intervention chirurgicale cardiaque ou vasculaire. On classifie le risque en risque habituel, accru ou élevé, selon la présence de facteurs aggravants du risque (mauvaise fonction ventriculaire, angor instable, âge, etc. …). On propose une évaluation du risque habituel pour certaines interventions courantes. Parmi les problèmes courants rencontrés chez ces malades, on retrouve entre autres des pathologies pulmonaires, des problèmes de coagulation, le diabète et l’insuffisance rénale. La prémédication utilisée chez ce type de malade et l ’ approche adoptée à l’ Institut de Cardiologie de Montréal y sont discutées.
Abstract
This text is intended for new residents in the department of anaesthesia of the Montreal Heart Institute. It presents a classification of the risk of cardiovascular surgery used in that institution and discusses current problems encountered with this type of patient (pulmonary and coagulation problems, diabetes renal failure). The attitudes of anaesthetists of this institution towards patients’ medication and premedication are also discussed. The risk is classified as usual, increased or high, depending on the presence (or absence) of several factors known to increase the risk: ventricular dysfunction, heart failure, unstable angina or recent infarction, significant involvement of other systems (unstable diabetes, renal insufficiency, significant pulmonary dysfunction), age, emergency surgery and non-cardiac surgery in the presence of important cardiac pathology. With surgical procedures carrying a high mortality, for example dissecting thoracic aneurysm, the usual risk is high and is classified as such. A table of the usual risk of current surgical procedures is proposed.
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Texte destiné aux résidents d’Anesthésie-Réanimation en stage à l’Institut de Cardiologie de Montréal.
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Paiement, B., Maillé, JG., Boulanger, M. et al. La visite pre-operatoire en chirurgie cardio-vasculaire. Canad. Anaesth. Soc. J. 27, 584–593 (1980). https://doi.org/10.1007/BF03006892
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DOI: https://doi.org/10.1007/BF03006892