ANESTHESIA AND MAJOR NONCARDIAC SURGERY

Modern anesthesia is one of the wonders of our age. In the properly prepared patient, current techniques for anesthesia permit a wide range of surgical procedures in a hemodynamically stable subject with relatively rapid postoperative recovery of mental and physiologic function. But all forms of surgery associated with general anesthesia carry a risk that must be estimated, however imprecisely, by the physicians called on to evaluate the patient preoperatively. Cardiac events including arrhythmia, myocardial infarction, and death have long been recognized as major factors for poor postoperative outcome. Forty years ago, Wroblewski and LaDue, using newly applied serum enzyme activity techniques, pointed out that there was a high incidence of potentially lethal myocardial infarction postoperatively. 1 Subsequently, Topkins and Artusio, 2 in a landmark article, described the high postoperative risk of patients who had had a myocardial infarction within the previous 6 months. In 1961, Dripps and coauthors 3 devised