TY  - CHAP
M1  - Book, Section
TI  - Chapter 44. Cardiovascular Drugs
A1  - Bronheim, David
A1  - Nicoara, Alina
A1  - Abel, Mark
A2  - Longnecker, David E.
A2  - Brown, David L.
A2  - Newman, Mark F.
A2  - Zapol, Warren M.
PY  - 2012
T2  - Anesthesiology, 2e
AB  - Patients  with  preoperative  blood  pressure  elevation  have  exaggerated  perioperative  blood  pressure  fluctuations,  which  may  be  associated  with  electrocardiogram  (ECG)  evidence  of  myocardial  ischemia.  The  American  College  of  Cardiology/American  Heart  Association  (ACC/AHA)  Guidelines  for  Perioperative  Cardiovascular  Evaluation  for  Noncardiac  Surgery  recommend  that  antihypertensive  medication  be  continued  during  the  perioperative  period.  Particular  care  should  be  taken  to  avoid  withdrawal  of  β-blockers  and  clonidine  because  of  the  potential  for  withdrawal  syndromes.Recommendations  for  patients  taking  diuretics  call  for  withholding  diuretics  on  the  day  of  surgery  unless  evidence  suggests  volume  overload  or  signs  and  symptoms  of  overt  congestive  heart  failure  (CHF).  In  stable  patients  with  chronic  mild-to-moderate  hypokalemia  without  signs  or  symptoms  of  hypokalemia  (eg,  muscle  weakness,  ileus,  and  nephropathy)  and  in  the  absence  of  dysrhythmias  or  digitalis  use,  anesthesia  and  surgery  can  proceed.α2-Agonists  have  many  desirable  effects,  such  as  minimum  alveolar  concentration  (MAC)  reduction,  analgesia,  anxiolysis,  sedation,  and  sympatholysis.  Recent  studies  evaluating  the  perioperative  effect  of  α2-agonists  during  noncardiac  surgery  show  less  perioperative  myocardial  ischemia.  The  ACC/AHA  guidelines  introduced  the  use  of  α2-agonists  as  a  class  IIb  recommendation  for  perioperative  control  of  hypertension  or  risk  reduction  in  patients  with  known  coronary  artery  disease  (CAD)  or  major  risk  factors  for  CAD.During  the  perioperative  period,  patients  maintained  on  angiotensin-converting  enzyme  (ACE)  inhibitors  and  angiotensin  II  receptor  blockers  through  the  morning  of  the  surgery  have  an  increased  number  of  hypotensive  episodes  requiring  treatment  with  vasopressors.Perioperatively,  intravenous  (IV)  nitroglycerin  may  be  used  for  treatment  of  myocardial  ischemia,  CHF,  acute  volume  overload,  systemic  and  pulmonary  hypertension,  and  coronary  artery  spasm.  It  enhances  blood  flow  to  the  subendocardium  and  areas  of  ischemia  by  both  decreasing  preload  and  left  ventricular  end-diastolic  pressure  and  volume.The  recent  focus  on  perioperative  β-blockade  has  led  to  mounting  evidence  that  their  prophylactic  use  will  reduce  cardiac  mortality  and  morbidity.  β-Blockers  reduce  ischemia  by  decreasing  myocardial  oxygen  demand  caused  by  increased  stress  and  catecholamine  release  in  the  perioperative  period.  However,  their  aggressive  prophylactic  use  without  proper  titration  may  result  in  an  increased  incidence  of  hypotension,  stroke,  and  mortality.  The  ACC/AHA  guidelines  state  that  β-blockers  should  be  titrated  to  effect  preferably  days  to  weeks  before  elective  surgery  in  patients  at  risk  for  or  with  evidence  of  ischemia.The  calcium  channel  blockers  represent  a  diverse  group  of  compounds  with  dissimilar  structures  and  pharmacologic  effects.  Unlike  β-blockers,  which  all  depend  on  blockade  of  receptors  for  their  activity,  the  sites  and  mechanisms  of  action  of  the  individual  calcium  channel  blockers  vary,  as  do  their  individual  actions  on  different  tissues.Over  the  past  decade,  the  use  of  most  antidysrhythmic  drugs  has  been  reassessed  and  dramatically  limited  as  a  result  of  increased  awareness  of  their  proarrhythmic  potential  and  advances  in  ablation  techniques.  Moreover,  recent  clinical  trials  have  demonstrated  negative  effects  on  survival  in  many  situations  when  these  drugs  may  have  been  administered  in  the  past.  Finally,  implantable  cardiodefibrillators  have  largely  replaced  antidysrhythmic  medications  in  the  management  of  ventricular  dysrhythmias.Amiodarone  is  considered  by  some  the  most  efficacious  antidysrhythmic  agent  available;  unfortunately,  however,  it  is  associated  with  a  high  incidence  of  side  effects.  In  the  intraoperative  and  postoperative  settings,  ...
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=56637475
ER  -