Cardiac disease anaesthesia
- Created by: Caroline Malik
- Created on: 20-11-19 09:46
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- Cardiac disease
- General considerations
- keep administering cardiac drugs as normal until time of anaesthesia
- avoid stressing patient out - dont want tachycardia
- pre oxygenate and administer O2 in recovery
- avoid fluid over loading, chose lower Na, hartmanns lower than saline 3/4ml/kg/hr
- ensure adequate anaestheisa
- need to know specifics of cardiac disease to tailor GA
- Murmur? need to know which valve
- Ausculatation of all 4 heart valves, noting grade and PMI of any murmurs
- full clinical examination
- MM colour, moistness and CRT
- Pulse quality and rate
- Ausculatation of all 4 heart valves, noting grade and PMI of any murmurs
- ausculattion of lung fields
- if any irregular rhythm is auscultated, concurrent pulse palpation should be performed to identify any pulse defects
- observation of RR and pattern
- ECG may be useful
- chest xrays can tell heart size and state of the lungs
- history incl exercise intolerance
- Murmur? need to know which valve
- Mitral and tricuspid regurgitation
- regurgitant flow of blood back into the atria, reducing the forward flow of blood
- often found in geriatric patients due to mitral valve endocardosis
- often in CKCS and small breeds
- Aims of anaesthesia
- produce a mild vasodilation
- try to increase HR slightly or to keep within pre anaesthetic values
- avoid bradycardia
- Hypertrophic cardiomyopathy (HCM)
- High output cardiac failure
- Often in cats with hyperthyroidism (so will have lots of other organ dysfunction)
- Muscular subaortic stenosisforms during systole, obstruction worsened with increasing HR and contractility and increased afterload.
- aims of anaesthesia
- supress HR
- supress ventricular arrhythmias
- maintain filling pressures
- maintain or slightly increase SVR
- Pulmonic stenosis
- a stenotic pulmonary valve limits right ventricular outflow
- in response to this right ventricular systolic pressure increases, often rendering the tricuspid valve inefficient
- aims of anaesthesia
- maintain contractility
- maintain or reduce HR
- maintain pre load
- avoid excessive IPPV pressures
- a stenotic pulmonary valve limits right ventricular outflow
- Aortic stenosis
- stenotic valve limits left ventricular outflow
- aims for anaesthesia
- avoid hypotension by maintaining SVR
- Maintain HR within 20% of baseline
- avoid factors reducing myocardial oxygen demand
- General considerations
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