Preface

The specialty journals of anesthesiology, cardiology, internal medicine, and surgery have witnessed a burgeoning interest in perioperative myocardial morbidity and mortality [1-6], This attention is attributable, at least partially, to an increased prevalence of major noncardiac surgical procedures in patients with known or probable coronary artery disease. Much of the work has been focused on the discovery of standard preoperative or special testing data that will predict postoperative cardiac and other complications. Along these lines, several investigators have explored the relationship between siient myocardial ischemia during the perioperative period and perioperative cardiac morbidity [4-6]，which is summarized in the chapter by Dr. Fleisher. The implication of these studies, which is only sometimes stated, is that patients identified as high-risk should undergo progressively more invasive procedures leading to prior repair of coronary lesions if correction is feasible, given the urgency of the contemplated surgery” [2]. Seldom considered is the possibility that perioperative care could be modified and developed to reduce risk, thus warranting us to proceed directly with the initially proposed operation. The enormous cost of extensive cardiac evaluation and revascularization [1]，as well as the cumulative risk of multiple surgeries, justifies a serious effort in the direction of improving perioperative care. Such an endeavor necessitates:(1)a systematic investigation of effective monitoring modalities, (2) an improved understanding of the mechanisms of cardiac and other morbidity, and (3) a willingness to develop and aggressively employ treatment of identified pathology and pathophysiology. Clearly, success in any of these approaches would be independently valuable to patient management in a variety ofclinical settings.