(精编)【高血压英文教学精品课件】 Anesthesia for Patients with Cardiovascular Disease.ppt

Anesthetic Management As far as positioning, the head down (Trendelenburg) position IS NOT well tolerated in these patients due to the increase in pulmonary blood volume that this position causes Monitoring Right Atrial Pressures is a helpful guide to the adequacy of your intravascular fluid replacement Postop Management Postop, patients with mitral stenosis are at HIGH risk for developing pulmonary edema and Right heart failure Mechanical support of ventilation of the lungs is often necessary postop, especially after major thoracic or abdominal surgery KEY POINTS FOR MS Avoid sinus tachycardia or rapid ventricular response rate from A-fib Avoid marked increases in central blood volume associated with over-hydration or head-down position Avoid drug induced decreases in SVR Avoid events such as hypoxemia or hypoventilation that may worsen Pulmonary Hypertension and cause Right heart failure Mitral Regurgitation Maintenance Detection of intraoperative ischemia should prompt a search for whatever the cause may be Oxygenation, BP, and Hematocrit should be checked and any hemodynamic irregularities (hypotension, hypertension, tachycardia) should be corrected immediately Anesthetic Technique Hematocrits 28% have been associated with perioperative ischemia and postop complications, particularly in patients undergoing vascular surgery Failure to ID a cause or to reverse the ischemia may indicate that NTG should be started As with your inhalation agents a careful balance between coronary vasodilation and drop in BP must be found or else you will just make the ischemia worse by dropping the perfusion pressure more with the NTG Muscle Relaxants Rocuronium, Vecuronium and Cis-atricurium are generally excellent choices for muscle relaxation in patients with CAD because of their lack of significant circulatory side effects Atricurium and Mivacurium can be used but in half their usual doses to avoid histamine mediated hypotension and consequently a drop in coronary perfusion Mus