Pathophysiology and Anesthetic Management of Patients with Cardiovascular Disease

Perkowski, Sandra Z.; Oyama, Mark A.

doi:10.1002/9781119421375.ch26

Cited by 21 publications

(10 citation statements)

References 84 publications

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“…42,28 Moreover, the presence of AF is another anaesthetic concern, as the characteristic uncoordinated atrial activity interferes with atrial contraction and leads to a reduced CO. 10 Methadone administered IV was expected to provide adequate perioperative sedation and analgesia with minimal effect on cardiovascular function. 43,44 Methadone may also decrease HR, which is desirable as tachycardia and AF increase myocardial oxygen demand and reduce CO. 45 For induction of general anaesthesia, midazolam was chosen to enhance the quality of sedation and muscle relaxation with no clinically detectable cardiovascular changes. 46 Propofol was chosen because of its rapid onset of action and good quality of induction.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management in a dog with constrictive pericarditis complicated with bi‐atrial enlargement and atrial fibrillation undergoing subtotal pericardiectomy

Martínez¹,

Charlesworth²,

Francis³

2022

Vet Record Case Reports

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A 2‐year 8‐month‐old female dobermann presented for a recheck after previous crown reduction and vital pulp therapy. On cardiac auscultation, rapid and irregularly irregular heart rhythm and irregular and asynchronous pulses were detected. On electrocardiogram and transthoracic echocardiogram, findings were suggestive of constrictive pericarditis complicated with bi‐atrial enlargement and atrial fibrillation. Subtotal pericardiectomy was performed. The patient was premedicated with methadone (0.2 mg/kg intravenously), and anaesthesia was induced with midazolam (0.2 mg/kg intravenously) and propofol (60 mg), and maintained with isoflurane in oxygen. Constant‐rate infusions of fentanyl (0.1–0.2 µg/kg/min) and lidocaine (50 µg/kg/min) were administered. Dobutamine (1–5 µg/kg/min) helped to maintain mean arterial blood pressure above 65 mmHg. Fluid resuscitation and noradrenaline infusion (0.1 µg/kg/min) started after constriction was released to optimise preload. Haemodynamic support and ventricular rate control continued during the immediate postoperative period. Recovery from general anaesthesia was uneventful.

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Section: Discussionmentioning

confidence: 99%

Anaesthetic management in a dog with constrictive pericarditis complicated with bi‐atrial enlargement and atrial fibrillation undergoing subtotal pericardiectomy

Martínez¹,

Charlesworth²,

Francis³

2022

Vet Record Case Reports

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“…Several factors during general anaesthesia may affect PVR. An increase in PVR is induced by hypoxaemia (hypoxic pulmonary vasoconstriction), intermittent positive pressure ventilation (IPPV), 9 and anaesthetic and vasoactive drugs including ketamine, phenylephrine and alpha‐2 adrenergic agonists. A decrease in PVR is induced by prolonged administration of high FiO 2 , 4 hypocapnia, alkalaemia, spontaneous ventilation (versus IPPV) and anaesthetic drugs such as acepromazine and sildenafil.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management of a dog with tetralogy of Fallot undergoing placement of a modified Blalock‐Taussig shunt

Veen

Szatmári

Vries³

et al. 2021

Vet Record Case Reports

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A 6‐month‐old male Old English Bulldog with tetralogy of Fallot (ToF) required general anaesthesia for surgical palliative treatment of ToF, whereby a shunt was placed between the left subclavian artery and the pulmonary trunk to increase pulmonary circulation (modified Blalock‐Taussig shunt). Anaesthesia of a patient with ToF presents an anaesthetic challenge given the four concurrent cardiac defects as well as the surgical manoeuvres involved, requiring an advanced understanding of the underlying pathophysiology and haemodynamics. Besides this, a thorough knowledge of the clinical effects of anaesthetic events and drugs is required. This case report describes the two major anaesthetic events that occurred and the unexplained hyperkalaemia that developed. Furthermore their management is explained and discussed.

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“…Methadone was expected to provide adequate perioperative sedation and analgesia (Hunt et al ., 2013). Moreover, it may decrease the HR, but maintaining CO, and increasing SV, which reduces oxygen myocardial consumption (Perkowski and Oyama, 2015). Therefore, methadone may be desirable as tachycardia and AF increase myocardial oxygen demand and reduce CO.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of a dog with severe subaortic stenosis and mitral valve disease complicated with atrial fibrillation undergoing ovariohysterectomy

2019

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The anesthetic management in patients with subaortic stenosis and mitral valve disease should involve intensive monitoring and the anesthesiologist’s main concern is to ensure oxygen delivery and tissue perfusion. Since anesthetic procedures in such patients are rare, there is no previous report about the anesthetic management. A 5.5-year old, 32-kg Boxer, suffering a severe heart disease due to a final stage subaortic stenosis and mitral insufficiency, was anesthetized for an ovariohysterectomy to remove an ovarian tumor that was producing high-volume ascites. Methadone (0.3 mg kg −1 ) was administered intramuscularly (IM) for pre-anesthetic medication, etomidate (1.3 mg kg −1 ) and midazolam (0.2 mg kg −1 ) were used for the induction of anesthesia and after endotracheal intubation, anesthesia was maintained with sevoflurane vaporized in oxygen and air. Fentanyl (5–10 μg kg −1 h −1 ) and paracetamol (15 mg kg −1 ) were administered to improve analgesia. Previous persistent atrial fibrillation was refractory to medication (digoxin, diltiazem, and pimobendan) and continued during the anesthetic procedure. Dobutamine (1.5–5 μg kg −1 minute −1 ) helped to maintain mean arterial blood pressure above 60 mmHg. Epidural morphine (0.1 mg kg −1 ) and incisional bupivacaine (2 mg kg −1 ) were administered at the end of surgery to provide postoperative analgesia. Anesthesia was otherwise uneventful, and recovery was considered excellent.

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Pathophysiology and Anesthetic Management of Patients with Cardiovascular Disease

Cited by 21 publications

References 84 publications

Anaesthetic management in a dog with constrictive pericarditis complicated with bi‐atrial enlargement and atrial fibrillation undergoing subtotal pericardiectomy

Anaesthetic management in a dog with constrictive pericarditis complicated with bi‐atrial enlargement and atrial fibrillation undergoing subtotal pericardiectomy

Anaesthetic management of a dog with tetralogy of Fallot undergoing placement of a modified Blalock‐Taussig shunt

Anesthetic management of a dog with severe subaortic stenosis and mitral valve disease complicated with atrial fibrillation undergoing ovariohysterectomy

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