MANEJO ANESTÉSICO DEL PACIENTE CARDIÓPATA EN CIRUGÍA NO CARDIACA: REVISIÓN SISTEMÁTICA
Palabras clave:
Anestesia perioperatoria, Cardiopatía, Cirugía no cardiacaResumen
DOI: https://doi.org/10.46296/yc.v9i17.0769
Resumen
Introducción: Los pacientes con enfermedad cardiovascular concentran una fracción relevante de la morbimortalidad perioperatoria. En la última década, sociedades científicas han emitido guías sobre evaluación cardiovascular, farmacoterapia, técnica anestésica, monitorización, manejo de dispositivos cardiacos implantables y vigilancia de lesión miocárdica posoperatoria. Objetivo: Sintetizar de forma sistemática las recomendaciones vigentes para el manejo anestésico del adulto con cardiopatía sometido a cirugía no cardiaca. Métodos: Revisión sistemática de guías/consensos (2015 2025) en repositorios de AHA/ACC, ESC, CHEST, ASA/HRS y ASRA. Se incluyeron documentos oficiales con metodología explícita aplicables al perioperatorio adulto. Síntesis cualitativa conforme a PRISMA 2020. Resultados: Se incluyeron 6 documentos (AHA/ACC 2024; ESC 2022; CHEST 2022; AHA 2021 MINS; ASA/HRS 2020 CIED; ASRA 2025). Convergen en: algoritmo por pasos para evaluación y uso juicioso de pruebas; continuidad/inicio de fármacos por indicación cardiovascular; interrupción y reinicio de antitrombóticos según riesgo; objetivos hemodinámicos que eviten hipotensión sostenida; vigilancia de troponina en alto riesgo; protocolo para CIEDs. Conclusiones: Las guías proporcionan un marco operativo para la práctica clínica; persisten lagunas en subpoblaciones (hipertensión pulmonar, ACHD compleja) y en superioridad de técnica anestésica.
Palabras claves: Anestesia perioperatoria, Cardiopatía, Cirugía no cardiaca.
Abstract
Introduction: Patients with cardiovascular disease account for a significant proportion of perioperative morbidity and mortality. Over the last decade, scientific societies have issued guidelines on cardiovascular assessment, pharmacotherapy, anesthetic techniques, monitoring, management of implantable cardiac devices, and surveillance of postoperative myocardial injury. Objective: To systematically summarize current recommendations for the anesthetic management of adults with heart disease undergoing noncardiac surgery. Methods: Systematic review of guidelines/consensus statements (2015 2025) in the AHA/ACC, ESC, CHEST, ASA/HRS, and ASRA repositories. Official documents with explicit methodology applicable to the adult perioperative period were included. Qualitative synthesis according to PRISMA 2020. Results: Six documents were included (AHA/ACC 2024; ESC 2022; CHEST 2022; AHA 2021 MINS; ASA/HRS 2020-CIED; ASRA 2025). They converge on: step by step algorithm for evaluation and judicious use of tests; continuity/initiation of drugs for cardiovascular indications; discontinuation and restarting of antithrombotics according to risk; hemodynamic targets to avoid sustained hypotension; troponin monitoring in high-risk patients; protocol for CIEDs. Conclusions: The guidelines provide an operational framework for clinical practice; gaps remain in subpopulations (pulmonary hypertension, complex ACHD) and in the superiority of anesthetic techniques.
Keywords: Perioperative anesthesia, Heart disease, Non-cardiac surgery.
Información del manuscrito:
Fecha de recepción: 17 de julio de 2025.
Fecha de aceptación: 27 de septiembre de 2025.
Fecha de publicación: 30 de octubre de 2025.
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