Expert: Ronald Levy, M.D. - 5/29/2008

Question
Hi, thank you for fielding this question.  I recently had surgery, and all is well, but today I read my cardiologist's letter clearing me for surgery.  He related that my EF was 60 percent, which it was a year ago, but did not mention that since my cancer treatment with Adriamycin, it has dropped to 50-55 percent.  He also used a pre-cancer treatment stress test I took a year ago to clear me.  I am curious, as an anesthesiologist, how important is it that the patient's EF and stress test info be up to date?  Do a few percentages in the EF make any difference while under anesthetic?  Again, much appreciated.  You're a gem.

Answer
It depends on the type of surgery. There is a checklist put out by the American Heart Association and the American Society of Anesthesiologists that tells anesthesiologists what tests are required for different types of surgery. For example, if you are having a low risk procedure (e.g. a hernia repair), then very few tests are required, whereas if you were having a major vascular procedure, we would want more recent studies.

As for the actual numbers, the percentages quoted are approximations and a few points here and there don't change prognosis. If your EF went from 60% to 30%, that would be significant but 5-10 points is no big deal (assuming we are starting from >50 and not <40)

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston