Introduction: Cardiac patients facing noncardiac surgery are at high risk for perioperative complications including hemodynamic instability, arrhythmias, and organ dysfunction that may require adjustment from standardized anesthetic protocols. Individualized deviations in anesthesia may offer improved safety but remain under-characterized across cardiac diagnoses and surgical contexts.
Methods: We systematically reviewed 15 cases (studies published 2000–2025) across 9 countries (3 in USA), involving adults with cardiac disease undergoing noncardiac thoracic surgery in which purposefully altered anesthesia management was implemented. Analyses were conducted using Google Colab; our protocol is registered to OSF. Subgroup comparisons explored perioperative complications and ICU transfers by diagnosis, surgery, and deviation type. Exploratory meta-regression (limited by sample size) was used to evaluate the impact of key variables on ICU transfer and complications.
Results: Mean age was 59.2 ± 14.1 years; 87% were male. Lobectomy and VATS procedures comprised most cases. The leading diagnoses were dilated cardiomyopathy and coronary artery disease. Most deviations (80%) occurred intraoperatively, with regional or advanced monitoring in 21% and 50% of cases, respectively. Common rationales included preventing hypotension, managing arrhythmic risk, and minimizing ventilatory burden. Major perioperative complications were avoided or controlled in 81%, and all patients survived to discharge (median: 5 days [IQR 3-8]). Subgroup trends suggested lower ICU transfer rates and improved stability with incorporating regional anesthetic techniques and enhanced monitoring. Exploratory regression supported associations between these approaches and reduced ICU use, but conclusions are limited by the small synthesized cohort.
Conclusions: Intentional anesthetic deviations appear to facilitate favorable perioperative outcomes and may reduce ICU needs in carefully selected cardiac patients undergoing noncardiac surgery. Results minimize the need for adaptable perioperative strategies and highlight key future targets like regional anesthesia and advanced hemodynamic monitoring. Prospective studies and multicenter registries require assessment to standardize definitions and confirm outcome associations in this high-risk group.
