(精选)Cardiovascular Complications related to Anesthesia教学课件.pptVIP

Cardiovascular Complications related to Anesthesia;Anesthetic Goals ;Anesthesia Incident Monitoring Study January to June 2007. 200,000 cases, 2537 incidents A standardized incident report form was developed in order to fill in what, where, when, how, and why it happened;Arrhythmia 25% Desaturation 24% Death within 24 hrs. 20% Cardiac arrest 14% ;inexperience, lack of vigilance, inadequate preanesthetic evaluation, inappropriate decision, emergency condition, haste, inadequate supervision, ineffective communication.;DO2 = CO x 10 x CaO2 Tissue O2 delivery = cardiac output x arterial O2 content CO = SV x HR SV ∞ preload, contractility, afterload CO = EF x LVEDV x SVR x HR;Patient’s comorbid : controllability? Anesthetic management : drugs, techniques, process, anesthesia personnel Surgical procedure;A. HYPOTENSION;Accessory for fast IV infusion;Colloids availability;1. Drug effect : nearly all anesthetic agents depress myocardial contractility Potent inhalation agents Nitrous oxide in compromised heart Intravenous : thiopental , propofol, ketamine Opioid : pethidine ( arrhythmogenic effect to be discussed later);Coronary artery disease Myocardial ischemia / infarct Cardiogenic shock Valvular heart disease Congestive heart failure most common rheumatic heart disease : mitral, aortic , tricuspid valve ;Acute ischemic episode ? large or significant myocardial loss ? serious ventricular arrhythmia, pulmonary congestion , hypotension ..... Hemodynamic support : inotropes , antiarrhythmic , mechanical device Cardiac markers : troponin I, AST, LDH, CK-MB cTnT 0.1 ng/L, cTnI 2.0 ng/L, CK-MB 0-25 u/L ( 2 x normal);Obstruction to heart, cardiac chambers or great vessels ? reduced stroke volume Causes : 1.Cardiac tamponade from injury, post cardiac surgery, cardiac catheterization * 2.Tension pneumothorax * 3. Pulmonary embolism * 4. Surgical manipulation in chest, esophageal, cardiac surgery 5. Supine hypotensive syndrome ;Acute onset of pulmona