Cardiomyopathies and Anesthesia
Marwa Mounir Zohdy;
Abstract
C
ardiomyopathy is a disease that affects the cardiac muscle. It could be classified pathophysiologically into three main types. The hemodynamic, clinical aspects and management differ from one type to another. They include:
1- HCM.
2- DCM.
3- RCM.
Preoperative assessment should include the determination of the type ofcardiac lesion, cardiac efficiency, the hemodynamic derangement and how itcould be compensated as well as the presence of associated diseases.
The anesthetic plan for cardiomyopathic patients undergoing non-cardiacsurgery should include specific and good monitoring of these patients whichdepends on the type of cardiac lesion, cardiac reserve and hemodynamic stateof these patients. Invasive blood pressure measurement during surgeryappears to be important. Also, it is very important to measure the fillingpressures of the right side of the heart and cardiac output through a Swan-Ganzcatheter to estimate the pulmonary artery pressure, pulmonary wedge pressureand cardiac output.
All of volatile anesthetic agents have a depressant effect on myocardialcontractility so they can be replaced by narcotic analgesics such as fentanyl,sulfentanyl and alfentanyl to ensure preservation of myocardial contractility.Precautions should be taken if regional anesthesia is considered, such asHR, blood pressure, CO and right atrial filling pressure.
It is important to study the type of surgery and the possibility of usinglocal techniques as well as the effect of spinal epidural block in cases ofsurgeries of the lower abdomen or lower limbs and the precautions to be takenif they are given e.g. monitoring of HR, systemic blood pressure, fillingpressures of the right side and CO in severe cases.The postoperative hemodynamic monitoring should be continued until thepatient becomes stable.
The follow up with blood gases is important as well, since, it could beaffected as a result of postoperative pain or affection of the respiratorydynamics after anesthesia with narcotics as fentanyl, sulfentanyl or alfentanyl.Drugs such as inotropes, calcium channel blockers and beta-blockersshould be continued after surgery according to the hemodynamic status.Congestive heart failure, cardiac dysrhythmia, hypotension, hypertension,nausea and vomiting and other expected complications must be treatedcarefully in the intensive care unit.
ardiomyopathy is a disease that affects the cardiac muscle. It could be classified pathophysiologically into three main types. The hemodynamic, clinical aspects and management differ from one type to another. They include:
1- HCM.
2- DCM.
3- RCM.
Preoperative assessment should include the determination of the type ofcardiac lesion, cardiac efficiency, the hemodynamic derangement and how itcould be compensated as well as the presence of associated diseases.
The anesthetic plan for cardiomyopathic patients undergoing non-cardiacsurgery should include specific and good monitoring of these patients whichdepends on the type of cardiac lesion, cardiac reserve and hemodynamic stateof these patients. Invasive blood pressure measurement during surgeryappears to be important. Also, it is very important to measure the fillingpressures of the right side of the heart and cardiac output through a Swan-Ganzcatheter to estimate the pulmonary artery pressure, pulmonary wedge pressureand cardiac output.
All of volatile anesthetic agents have a depressant effect on myocardialcontractility so they can be replaced by narcotic analgesics such as fentanyl,sulfentanyl and alfentanyl to ensure preservation of myocardial contractility.Precautions should be taken if regional anesthesia is considered, such asHR, blood pressure, CO and right atrial filling pressure.
It is important to study the type of surgery and the possibility of usinglocal techniques as well as the effect of spinal epidural block in cases ofsurgeries of the lower abdomen or lower limbs and the precautions to be takenif they are given e.g. monitoring of HR, systemic blood pressure, fillingpressures of the right side and CO in severe cases.The postoperative hemodynamic monitoring should be continued until thepatient becomes stable.
The follow up with blood gases is important as well, since, it could beaffected as a result of postoperative pain or affection of the respiratorydynamics after anesthesia with narcotics as fentanyl, sulfentanyl or alfentanyl.Drugs such as inotropes, calcium channel blockers and beta-blockersshould be continued after surgery according to the hemodynamic status.Congestive heart failure, cardiac dysrhythmia, hypotension, hypertension,nausea and vomiting and other expected complications must be treatedcarefully in the intensive care unit.
Other data
| Title | Cardiomyopathies and Anesthesia | Other Titles | أمراض اعتلال عضلة القلب وعلاقته بالتخدير | Authors | Marwa Mounir Zohdy | Issue Date | 2014 |
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