Cardiac disease anaesthesia

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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
    • 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
    • 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


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