anesthesia and sedation for patients with CV disease Flashcards
golden rules
dx condition
stabilize when possible
current medications
evaluate volume status-avoid fluid overload
maintain normal HR
avoid profound changes in SVR and contractility
monitor!!!
minimize stress and SNS stimulation
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
avoid factors that increase myocardial oxygen demand
tachycardia
increased afterload
increased contractility
increased metabolism
hypertrophic cardiomyopathy overview
stiff, hypertropic LV
poor diastolic function
low end diastolic volume
ventricular function decreases
+/- CHF
hyertrophic cardiomyopathy sedation/anesthesia
avoid tachycardia
opioid + benzo combo
no alpha 2s
pre-oxygenate
etomidate or propofol
maintenance with sevo or isoflurane +/- adjunct
careful fluid administration
monitoring
dilated cardiomyopathy overview
poor systolic function
chamber enlargement
+/- arrhythmias
+/- CHF
dilated cardiomyopathy sedation/anesthesia
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
pericardial effusion overview
cardiac tamponade-decreased SV and hypotension
+/- CHF
+/- Anemia, hypoproteinemia
pericardial effusion sedation and anesthesia
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
atrioventricular valve disease overview
mitral or tricupsid insufficiency
regurgitant flow
decreased SV, CO
LA or RA volume overload
atrioventricular valve disease sedation/anesthesia
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
patent ductus arteriosis overview
left to right shunt
pediatric
patent ductus arteriosis sedation/anesthesia
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
subaortic stenosis overview
decreased SV
decreased CO
increased LV pressure
subaortic stenosis sedation and anesthesia
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
heartworm disease overview
depends on worm burden
CO normal to greatly reduced
pulmonary hypertension
risk of pulmonary embolism
heartworm sedation/anesthesia
if no clinical signs, any appropriate protocol for patient’s signalment and hx
if clinical-anesthesia postponed
caval syndrome–>refer
second degree av block type 1
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
ventricular premature contractions
many causes: myocarditiis, ischemia, hypoxemia, electrolyte imbalances, pain, catecholamine release, systemic disease
tx for ventricular premature contractions
based on MAP, frequency (>3), rate (over 160-180 bpm), electrically unstable characteristics (multifocal, multiform, R on T)
lidocaine
atrial fibrillation
no P waves
tachycardia
supraventricular
irregularly irregular
atrial fibrillation tx
necessary prior to elective procedure
aimed at slowing ventricular rate by slowing conduction through AV node-calcium channel blockers, beta blockers, digoxin
