Anesthetic Considerations in Patients After Valve Replacements and Cardiac Stents, with Associated Anticoagulation Concerns

Geriatric patients are a significant proportion of the patients seen in the perioperative setting. Oftentimes, these patients are presenting for non-cardiac surgery after undergoing a cardiac procedure previously. Management of these patients starts with understanding the pathophysiology, surgical intervention, and anesthetic considerations. This management starts from risk assessment and perioperative management. In this chapter, risk assessment stemming from a patient’s co-morbid conditions is taken into account to form an overall risk profile. These conditions help the anesthesiologist establish a framework to model an anesthetic plan. Notably, a prior cardiac history, including a history of coronary artery disease (CAD), hypertension (HTN), and a history of valve disease and possible repair, is prudent. Also discussed is the need for appropriate intra-operative monitoring in specific situations as well as anticoagulation guidelines in the pre and post-operative settings.