Key Points 1. With monitored anesthesia care, the stress response to surgery may not be adequately blocked, and the resulting tachycardia may aggravate the patient's underlying cardiac disease. 2. A decrease in minute ventilation and increase in carbon dioxide associated…
Key Points 1. Intraoperative hemodynamic instability may be associated with increased cardiovascular complications and represents one of the most common findings associated with mortality. 2. Phenylephrine can be used for the treatment of intraoperative hypotension through an increase in stroke…
Key Points 1. The portability, ease of use, and rapid diagnostic capability of transesophageal echocardiography (TEE) make it the diagnostic modality of choice during acute hemodynamic instability. 2. Qualitative analysis of a condensed TEE examination aids in efficiency during the…
Key Points 1. Excellent cardiac and hemodynamic management is essential to achieving good outcomes in patients with cardiovascular disease, particularly those undergoing high-risk noncardiac surgery. 2. Much cardiovascular information can be obtained from the standard American Society of Anesthesiologists monitors,…
Key Points 1. Because of successes in treating congenital cardiac lesions, there are currently as many as or more adults than children with congenital heart disease (CHD). 2. Noncardiac anesthesiologists see these patients for a vast array of ailments and…
Key Points 1. Pulmonary hypertension (PH) is a rare disease with a high degree of morbidity and mortality for patients undergoing noncardiac surgery. 2. PH, although having several classification schemes, can be largely divided into high pulmonary venous pressure (typically…
Key Points 1. Cardiac transplant is the definitive treatment of advanced heart failure and has demonstrated improving outcomes and long-term survival. 2. The transplanted heart receives no neural modulatory signal in the posttransplant period and is dependent on filling and…
Key Points 1. Regardless of the level of complexity or invasiveness of the planned procedure, the perioperative considerations and the anesthetic approach to left ventricular assist device (LVAD)–supported patients are the same because the removal of sympathetic tone by sedation…
Key Points 1. Active fixation leads can penetrate through structures (e.g., the thin-walled right atrium) during placement and present as pain, pneumomediastinum, or effusions. 2. Active rate modulation in cardiac implantable electrical devices (CIEDs) may result in heart rate changes…
Key Points 1. Percutaneous coronary intervention (PCI) with stent placement is frequently performed, with a substantial number of patients requiring subsequent noncardiac surgery (NCS). 2. Three types of stents are currently available for clinical use: bare metal stents (BMSs), drug-eluting…