Anesthesia and the patient with pericardial disease

Abstract

Purpose Pericardial diseases present unique perioperative considerations for the anesthesiologist. The purpose of this review is to provide a summary of the pertinent issues related to the etiology, diagnosis, pathophysiology, and perioperative management of patients presenting for operative treatment of pericardial disease. Source A selective search of the anesthesia, cardiology, and cardiothoracic surgical literature was carried out with particular emphasis on acute pericarditis, effusion, tamponade, and constrictive pericarditis Principal findings The anesthesiologist needs to be well versed in the etiology (i.e., differential diagnosis), pathophysiology, and diagnostic modalities in order to best prepare the patient for surgery. Diagnosis and guidance of management requires a working knowledge of the specific associated hemodynamic consequences, particularly of the impaired diastolic function that can occur. Echocardiography is essential in the diagnosis and management of these patients. Conclusions Patients with acute and chronic pericardial diseases often require the need for surgical intervention. Several unique features of acute tamponade and constrictive pericarditis require careful perioperative consideration. With proper preparation and pre-anesthetic optimization, patients with a variety of pericardial diseases can be safely managed before, during, and after their surgical intervention.

Anesthesia for children with pericardial effusion: a case series

“…Late diastolic collapse of the right atrium has a reported sensitivity for cardiac tamponade of 50–100% and specificity of 33–100%, while early diastolic collapse of the right ventricle has sensitivity of 48–100% and specificity of 72–100% (14). Other morphologic features include a dilated inferior vena cava with lack of inspiratory collapse, abnormal septal and mitral valve motion, and decreases in trans‐mitral valve flow velocities (in spontaneously breathing patients)(15). Even small volumes of fluid collecting in the pericardial space may cause the characteristic features of cardiac tamponade, particularly if the accumulation is rapid and allows no time for compensation (16).…”

Pericardial tamponade caused by massive fluid resuscitation in a patient with pericardial effusion and end-stage renal disease -A case report-

“…When pericardial effusion slowly develops, intrathoracic pressure gradually increases due to stretched parietal pericardium and the heart endures to some extent although 1-2 L of fluid is accumulated. However, pericardial tamponade may result from drastically increased intrathoracic pressure when pericardial effusion rapidly develops [8]. Therefore, prompt diagnosis and treatment need to be immediately implemented when pericardial tamponade is suspected [9].…”

“…Anesthetic management of pericardial effusion and tamponade requires thorough review of the pre-anesthetic evaluation and anesthetic methods [8]. In this case report, examining the medical history and laboratory results of the patient was problematic due to the nature of emergency surgery and a computer network error.…”

“…Although the surgeons were aware of the fact that the patient was receiving hemodialysis due to end-stage renal failure, we were unable to take into account the possibility of pericardial tamponade induced by pericardial effusion due to more urgent massive intrathoracic bleeding. Moreover, it is critical to prevent interference with venous return due to increased airway pressure during positive pressure ventilation [8]. In this case, PaCO 2 reached excessively high levels because adequate ventilation was not performed due to high airway pressure during OLV and underlying pulmonary diseases (Table 1).…”

“…However, pericardiocentesis should not be delayed due to placement of central venous catheter. Fluids, blood products, vasopressor, and other medications should be prepared and potential arrhythmia that may develop while manipulating the pericardium and heart should be dealt with by defibrillation [8]. An elevated preload should be sustained during aesthesia and maintaining normal heart rate, afterload, contractility, and sinus rhythm is crucial [5,8].…”