CVD in Surgical Patients

Question 1

effects of anesthetics on CV system

Answer 1

*reduce contractility
*reduce SVR
*reduce MAP
*respiratory depression

Question 2

how to approach undergoing surgery in patients with coronary artery disease

Answer 2

*estimate risk using one of the calculators (Revised Cardiac Risk Index, etc)
*criteria typically includes: age, history of heart disease, history of diabetes, history of kidney disease, history of stroke, type of surgery
*may need to consider stress testing to see if the heart can undergo general anesthesia

Question 3

how to approach undergoing surgery in patients with aortic stenosis

Answer 3

*avoid tachycardia
*ensure adequate preload
*maintain aortic diastolic pressure
*sinus rhythm is optimal

Question 4

how to approach undergoing surgery in patients with mitral stenosis

Answer 4

*slower HR (no time in diastole means there is no filling of the ventricles)
*maintain SVR
*maintain preload (too little causes decreased CO; too much causes pulmonary edema)

Question 5

how to approach undergoing surgery in patients with tricuspid regurgitation

Answer 5

*need increased preload (but not too much)
*avoid bradycardia
*maintain contractility (RV failure will likely worsen TR)
*avoid conditions that promote increased pulmonary vascular resistance (avoid hypercarbia, hypoxia, acidosis, hypothermia, and high airway pressures)

Question 6

how to approach undergoing surgery in patients with mitral regurgitation

Answer 6

*need increased preload (but not too much)
*avoid bradycardia
*maintain contractility (LV failure will likely worsen MR due to dilation)
*avoid high afterload (avoid increased SVR)
*“full, fast, and forward”