RT Book, Section
A1 Reich, David L.
A1 Mittnacht, Alexander J.C.
A1 Kaplan, Joel A.
A2 Fuster, Valentin
A2 Harrington, Robert A.
A2 Narula, Jagat
A2 Eapen, Zubin J.
SR Print(0)
ID 1191188056
T1 ANESTHESIA AND THE PATIENT WITH CARDIOVASCULAR DISEASE
T2 Hurst's The Heart, 14e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071843249
LK accesscardiology.mhmedical.com/content.aspx?aid=1191188056
RD 2024/04/18
AB SummaryThis  chapter  discusses  anesthesia  in  patients  with  cardiovascular  disease.  Multiple  factors  must  be  considered  when  choosing  an  anesthetic  technique:  the  patient’s  preferences,  the  requirements  of  the  surgical  procedure,  and  the  patient’s  underlying  medical  condition(s)  (see  accompanying  Hurst’s  Central  Illustration).  Almost  all  general  anesthetics  have  cardiovascular  adverse  effects  and  also  mask  many  of  the  symptoms  of  cardiovascular  decompensation.  Moreover,  pharmacological  reversal  of  nondepolarizing  neuromuscular  blocking  drugs  can  lead  to  arrhythmias  in  patients  with  cardiovascular  disease  and  has  been  associated  with  cardiac  arrest  in  patients  with  prior  heart  transplants.  Certain  anesthetic  techniques,  such  as  neuraxial  anesthesia,  may  be  contraindicated  in  the  presence  of  certain  antithrombotic  regimens.  Spinal  anesthesia  is  contraindicated  in  patients  with  severe  valvular  stenosis  or  hypertrophic  obstructive  cardiomyopathy  but,  with  appropriate  monitoring,  cautious  administration  of  epidural  anesthesia  may  be  performed  safely  in  these  patients.  Inadvertent  intravascular  injection  or  absorption  of  local  anesthetics  can  cause  severe  arrhythmias,  including  ventricular  fibrillation  and  cardiovascular  collapse.  Additionally,  epinephrine  and  phenylephrine  may  be  added  in  small  doses  to  prolong  the  duration  of  action  of  local  anesthetics,  but  result  in  slight  tachycardia  and  diastolic  hypotension,  which  is  undesirable  in  patients  with  certain  cardiovascular  diseases.  With  all  forms  of  anesthesia,  appropriate  monitoring  technology  must  be  applied  intraoperatively.  The  anesthesiologist  should  be  prepared  to  manage  hemodynamic  alterations  and  analgesic  requirements  in  the  postoperative  period.