anesthesia and sedation for patients with CV disease

Question 1

golden rules

Answer 1

dx condition

stabilize when possible

current medications

evaluate volume status-avoid fluid overload

maintain normal HR

avoid profound changes in SVR and contractility

monitor!!!

Question 2

minimize stress and SNS stimulation

Answer 2

use premeds

achieve adequate depth prior to intubation

provide analegsia

avoid hypotension, hypercapnia, hypoxemia

avoid hyperthermia and hypothermia

avoid hypoglycemia

+/- minimize SNS stimulating drugs-anti-cholingergics, sympathomimetics, etc

Question 3

avoid factors that increase myocardial oxygen demand

Answer 3

tachycardia

increased afterload

increased contractility

increased metabolism

Question 4

hypertrophic cardiomyopathy overview

Answer 4

stiff, hypertropic LV

poor diastolic function

low end diastolic volume

ventricular function decreases

+/- CHF

Question 5

hyertrophic cardiomyopathy sedation/anesthesia

Answer 5

avoid tachycardia

opioid + benzo combo

no alpha 2s

pre-oxygenate

etomidate or propofol

maintenance with sevo or isoflurane +/- adjunct

careful fluid administration

monitoring

Question 6

dilated cardiomyopathy overview

Answer 6

poor systolic function

chamber enlargement

+/- arrhythmias

+/- CHF

Question 7

dilated cardiomyopathy sedation/anesthesia

Answer 7

support contractility

avoid increased in SvR and decreases in preload

Opioid+Benzo combo

pre-oxygenate

etomidate (or propofol)

maintenance with sevo or isoflurane +/- adjunct

positive inotrope

careful with fluid administration

monitoring

Question 8

pericardial effusion overview

Answer 8

cardiac tamponade-decreased SV and hypotension

+/- CHF

+/- Anemia, hypoproteinemia

Question 9

pericardial effusion sedation and anesthesia

Answer 9

maintain SV, preload

pericardiocentesis

opioid + benzo + LA

pre-oxygenate

any induction agent

maintenance with sevo or iso +/- adjunct

increase fluid administration (if not in CHF)

monitor

Question 10

atrioventricular valve disease overview

Answer 10

mitral or tricupsid insufficiency

regurgitant flow

decreased SV, CO

LA or RA volume overload

Question 11

atrioventricular valve disease sedation/anesthesia

Answer 11

maintain SV, avoid increase in SvR

opioid+benzo or low dose acepromazine +/-anticholinergic

pre-oxygenate

propofol, Ket/Val

maintenance with sevo or iso +/- adjunct

careful with fluid administration

monitor

Question 12

patent ductus arteriosis overview

Answer 12

left to right shunt

pediatric

Question 13

patent ductus arteriosis sedation/anesthesia

Answer 13

maintain HR

avoid increases in SVR

maintain glucose concentrations

opioid+benzo+/-anticholingerics

pre-oxygenate

propofol, ket/val

maintenance with sevo or iso +/- adjunct

careful fluid administration

monitor

Question 14

subaortic stenosis overview

Answer 14

decreased SV

decreased CO

increased LV pressure

Question 15

subaortic stenosis sedation and anesthesia

Answer 15

prevent decreases in SVR

maintain normal HR, NSR

maintain preload

opioid + benzo

pre-oxygenate

propofol

maintenance with sevo or iso + adjunct

careful fluid administration

monitor

Question 16

heartworm disease overview

Answer 16

depends on worm burden

CO normal to greatly reduced

pulmonary hypertension

risk of pulmonary embolism

Question 17

heartworm sedation/anesthesia

Answer 17

if no clinical signs, any appropriate protocol for patient’s signalment and hx

if clinical-anesthesia postponed

caval syndrome–>refer

Question 18

second degree av block type 1

Answer 18

occasional flairue of conduction through AV node

common with increase in vagal tone-opioids, alpha 2 agonist

treatment may not be necessary-look at MAP, HR, anticholingeric

Question 19

ventricular premature contractions

Answer 19

many causes: myocarditiis, ischemia, hypoxemia, electrolyte imbalances, pain, catecholamine release, systemic disease

Question 20

tx for ventricular premature contractions

Answer 20

based on MAP, frequency (>3), rate (over 160-180 bpm), electrically unstable characteristics (multifocal, multiform, R on T)

lidocaine

Question 21

atrial fibrillation

Answer 21

no P waves

tachycardia

supraventricular

irregularly irregular

Question 22

atrial fibrillation tx

Answer 22

necessary prior to elective procedure

aimed at slowing ventricular rate by slowing conduction through AV node-calcium channel blockers, beta blockers, digoxin