Precise perioperative assessment and anesthesia strategy for painless gastrointestinal endoscopy in high-risk cardiovascular disease patients

= 0.107 mg/kg in Child-Pugh B cirrhosis). Third, precision intraoperative monitoring, including invasive arterial pressure, stroke volume variation, and capnography, enables early identification and targeted management of hypotension and hypoxemia. Finally, physiology-based discharge criteria emphasizing hemodynamic stability, respiratory adequacy, and neurologic recovery reduce delayed complications and unplanned readmissions. Transitioning from static preprocedural assessment to dynamic physiologic management substantially enhances perioperative safety in high-risk cardiovascular patients undergoing PGE. Integrating predictive risk models, tailored pharmacology, advanced monitoring, and physiology-based discharge protocols is associated with meaningful reductions in cardiopulmonary complications. Future randomized trials are needed to validate pharmacogenomic-guided dosing and closed-loop sedation systems, but maintaining hemodynamic stability (mean arterial pressure ≥ 65 mmHg) remains a central priority for improving outcomes in this vulnerable population.