Cardio Anesthesia

Question 1

goals for MMVD anesthesia?

Answer 1

1. no crazy fluids
2. no bradycardia
3. reduce afterload

opioids are integral to premed!
+benzos or ace

induction: propofol or alfax
-if significant systolic dysfunction: etomidate (heart failure)

avoid ketamine to avoid excessive vasoconstriction!!

propofol + midazolam is great

add locoregional anesthesia to avoid amount of inhalant used

BP SUPPORT: to fix hypotension, DOBUTAMINE IS DRUG OF CHOICE (increases contractility)

Question 2

DCM anesthetic considerations?

Answer 2

maintain forward blood flow

concerns:
-severe decreased systolic function which can lead to CHF (etomidate!)
-increased arrhythmias (lidocaine!)

Question 3

HCM anesthetic considerations?

Answer 3

goal: optimize diastolic filling (maintain low HR, avoid increasing contractility)

premed:
-opioid + alfax or benzo
-avoid ketamine (catecholamine release = goal killer)

frequent hypotension! but need VASOPRESSORS NOT INOTROPES (dopamine or phenylephrine)

Question 4

heart murmur found?

Answer 4

cardiac friendly (propofol, opioid, etc.)

keep cardiac meds going EXCEPT ACE inhibitors (don’t want hella vasodilation = hypotension in anesthesia)