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Coronary arteri disease
Butterworth IV, J. F., Mackey, D. C., & Wasnick, J. D. (2013). Morgan & Mikhail’s. Clinical Anesthesiology.
Butterworth IV, J. F., Mackey, D. C., & Wasnick, J. D. (2013). Morgan & Mikhail’s. Clinical Anesthesiology.
The general approach in treating patients with
ischemic heart disease is five-fold:
• Correction of risk factors, with the hope of slowing disease progression
• Modification of the patient’s lifestyle to reduce stress and improve exercise
tolerance
• Correction of complicating medical conditions that can exacerbate ischemia (ie,
hypertension, anemia, hypoxemia, hyperthyroidism, fever, infection, adverse drug
effects)
• Pharmacological manipulation of the myocardial oxygen supply–demand
relationship
• Anticoagulation
• Correction of coronary lesions by percutaneous coronary intervention
(angioplasty
[with or without stenting] or atherectomy) or coronary artery bypass surgery
Butterworth IV, J. F., Mackey, D. C., & Wasnick, J. D. (2013). Morgan & Mikhail’s. Clinical Anesthesiology.
PREOPERATIVE MANAGEMENT
• Most studies confirm that perioperative outcome is related to disease
severity, ventricular function, and the type of surgery to be
undertaken.
• Patients with extensive (three-vessel or left main) CAD, a recent
history of MI, or ventricular dysfunction are at greatest risk of
cardiovascular complications
• The relationship between symptoms and activity level should be
established
• Normal serum levels of troponins, creatine kinase (MB isoenzyme),
and lactate dehydrogenase (type 1 isoenzyme) are useful in excluding
MI.
Butterworth IV, J. F., Mackey, D. C., & Wasnick, J. D. (2013). Morgan & Mikhail’s. Clinical Anesthesiology.
• Prior infarction may be manifested by Q waves or loss of R waves in
the leads closest to the infarct. First-degree AV block, bundle-branch
block, or hemiblock may be present. Persistent ST-segment elevation
following MI may be indicative of a left ventricular aneurysm
• The chest radiograph can be used to exclude cardiomegaly or
pulmonary vascular congestion secondary to ventricular dysfunction
Butterworth IV, J. F., Mackey, D. C., & Wasnick, J. D. (2013). Morgan & Mikhail’s. Clinical Anesthesiology.
Premedication
• Allaying fear, anxiety, and pain preoperatively are desirable goals in
patients with CAD
• Satisfactory premedication minimizes sympathetic activation, which
adversely affects the myocardial oxygen supply–demand balance
• Midazolam 0,02 mg/kg: 60 x0,02: 1,2 mg
Butterworth IV, J. F., Mackey, D. C., & Wasnick, J. D. (2013). Morgan & Mikhail’s. Clinical Anesthesiology.
INTRAOPERATIVE MANAGEMENT
• Activation of the sympathetic system plays a major role. Hypertension
and enhanced contractility increase myocardial oxygen demand,
whereas tachycardia increases demand and reduces supply.
• Myocardial ischemia is commonly associated with tachycardia,
Butterworth IV, J. F., Mackey, D. C., & Wasnick, J. D. (2013). Morgan & Mikhail’s. Clinical Anesthesiology.
Coronary arthehsjsjsjssnderi disease.pptx

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Coronary arthehsjsjsjssnderi disease.pptx

  • 2. Butterworth IV, J. F., Mackey, D. C., & Wasnick, J. D. (2013). Morgan & Mikhail’s. Clinical Anesthesiology.
  • 3. Butterworth IV, J. F., Mackey, D. C., & Wasnick, J. D. (2013). Morgan & Mikhail’s. Clinical Anesthesiology.
  • 4.
  • 5. The general approach in treating patients with ischemic heart disease is five-fold: • Correction of risk factors, with the hope of slowing disease progression • Modification of the patient’s lifestyle to reduce stress and improve exercise tolerance • Correction of complicating medical conditions that can exacerbate ischemia (ie, hypertension, anemia, hypoxemia, hyperthyroidism, fever, infection, adverse drug effects) • Pharmacological manipulation of the myocardial oxygen supply–demand relationship • Anticoagulation • Correction of coronary lesions by percutaneous coronary intervention (angioplasty [with or without stenting] or atherectomy) or coronary artery bypass surgery Butterworth IV, J. F., Mackey, D. C., & Wasnick, J. D. (2013). Morgan & Mikhail’s. Clinical Anesthesiology.
  • 6. PREOPERATIVE MANAGEMENT • Most studies confirm that perioperative outcome is related to disease severity, ventricular function, and the type of surgery to be undertaken. • Patients with extensive (three-vessel or left main) CAD, a recent history of MI, or ventricular dysfunction are at greatest risk of cardiovascular complications • The relationship between symptoms and activity level should be established • Normal serum levels of troponins, creatine kinase (MB isoenzyme), and lactate dehydrogenase (type 1 isoenzyme) are useful in excluding MI. Butterworth IV, J. F., Mackey, D. C., & Wasnick, J. D. (2013). Morgan & Mikhail’s. Clinical Anesthesiology.
  • 7. • Prior infarction may be manifested by Q waves or loss of R waves in the leads closest to the infarct. First-degree AV block, bundle-branch block, or hemiblock may be present. Persistent ST-segment elevation following MI may be indicative of a left ventricular aneurysm • The chest radiograph can be used to exclude cardiomegaly or pulmonary vascular congestion secondary to ventricular dysfunction Butterworth IV, J. F., Mackey, D. C., & Wasnick, J. D. (2013). Morgan & Mikhail’s. Clinical Anesthesiology.
  • 8. Premedication • Allaying fear, anxiety, and pain preoperatively are desirable goals in patients with CAD • Satisfactory premedication minimizes sympathetic activation, which adversely affects the myocardial oxygen supply–demand balance • Midazolam 0,02 mg/kg: 60 x0,02: 1,2 mg Butterworth IV, J. F., Mackey, D. C., & Wasnick, J. D. (2013). Morgan & Mikhail’s. Clinical Anesthesiology.
  • 9. INTRAOPERATIVE MANAGEMENT • Activation of the sympathetic system plays a major role. Hypertension and enhanced contractility increase myocardial oxygen demand, whereas tachycardia increases demand and reduces supply. • Myocardial ischemia is commonly associated with tachycardia, Butterworth IV, J. F., Mackey, D. C., & Wasnick, J. D. (2013). Morgan & Mikhail’s. Clinical Anesthesiology.