Anesthesia and the Cardiac Patient麻醉和心脏病患者.pptVIP

* ACE Inhibitors Are effective in reducing ischemic effects after MI Treatment should be instituted within the 1st 24 hours of all pt’s with acute mi complicated by symptomatic or asymptomatic left ventricular dysfunction * ACE Inhibitors Contraindicated in pt’s with hypotension, bilateral renal artery stenosis, history of a cough or angio-edema with ace inhibitors * Aspirin ASA benefit well established as a secondary prevention Antiplatelet therapeutic dose (75-325mg/day) other antiplatelet agents such as dipyridamole are not supported in the literature except in pt’s with allergies to ASA who are poor candidates to oral anticoagulants * Anticoagulants Studies of anticoagulant treatment after mi show reduction in death, recurrent MI, and thromboembolitic complications However, trials comparing warafin to ASA for secondary prevention show no difference in recurrent infarction or death * Anticoagulants Are indicated for pt’s with ASA intolerance and for those at risk of embolisation from left ventricular or atrial clot(i.e. persistent atrial fib) * Lipid Lowering Agents meta analysis of clinical trials show that lipid lowering agents produce a reduction in fatal and non-fatal MI’s and cardiovascular deaths Should be given to pt’s with LDL concentration 3.37 mmol/1 Clonidine Less hypertension Decreased anesthesia requirements Anesthetic Management Regional vs. general Anesthetic management skills more important than technique Safest technique is the one the practitioner does best Regional Anesthesia Monitor patient more accurately Control sympathetic responses Fluids Esmolol General anesthesia Avoids sympathectomy Risks with intubation Sympathetic stimulation Hypoxia Increased catecholamines Loss of subjective monitor Chest pain Ischemia General Anesthesia required Narcotics Effective control of catecholamines Respiratory depression Prolonged ventilation Lidocaine Blunt effects of intubation 1.5 mg/kg 4-6 minutes prior to intubation Nitrous Oxide Rarely used due to: