RT Book, Section
A1 Bronheim, David
A1 Nicoara, Alina
A1 Heller, Joshua
A1 Gallambardo, Joseph
A1 Bronheim, Rachel
A2 Longnecker, David E.
A2 Mackey, Sean C.
A2 Newman, Mark F.
A2 Sandberg, Warren S.
A2 Zapol, Warren M.
SR Print(0)
ID 1144119250
T1 Cardiovascular Drugs
T2 Anesthesiology, 3e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071848817
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1144119250
RD 2024/04/20
AB KEY  POINTSPatients  with  preoperative  blood  pressure  elevation  have  exaggerated  perioperative  blood  pressure  fluctuations.  The  American  College  of  Cardiology/American  Heart  Association  (ACC/AHA)  Guideline  on  Perioperative  Cardiovascular  Evaluation  and  Management  of  Patients  Undergoing  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.1Recommendations  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  asymptomatic  patients  with  chronic  mild-to-moderate  hypokalemia  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.  However,  in  the  large  multicenter,  international,  double-blinded,  randomized,  controlled  Perioperative  Ischemic  Evaluation  2  (POISE-2)  trial,  clonidine  did  not  reduce  the  rate  of  death  or  nonfatal  myocardial  infarction,  but  it  did  increase  the  rate  of  nonfatal  cardiac  arrest  and  clinically  important  hypotension.2  The  2014  ACC/AHA  Guideline  on  Perioperative  Cardiovascular  Evaluation  and  Management  of  Patients  Undergoing  Noncardiac  Surgery  do  not  recommend  administration  of  α2-agonists  for  prevention  of  cardiac  events  in  patients  undergoing  noncardiac  surgery.2During  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  but  no  difference  in  outcome.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  left  ventricular  end-diastolic  pressure  and  volume  and  improving  blood  flow  to  areas  of  ischemia.Multiple  studies  demonstrated  that  prophylactic  perioperative  β-blockade  reduces  cardiac  mortality  and  morbidity.  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.  This  should  occur  preferably  with  drugs  other  than  metoprolol  days  to  weeks  before  elective  surgery  in  patients  at  risk  for  or  with  evidence  of  ischemia  or  high  Revised  Cardiac  Risk  Index  scores.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.The  use  of  most  antidysrhythmic  drugs  has  been  dramatically  limited  because  of  increased  awareness  of  their  proarrhythmic  potential  and  their  negative  impact  on  survival.  Advances  in  ablation  techniques  and  the  widespread  use  of  implantable  cardioverter-defibrillators  have  largely  replaced  antidysrhythmic  medications  in  the  management  of  ventricular  dysrhythmias.Amiodarone  is  considered  by  some  the  most  efficacious  antidysrhythmic  agent  available.  In  the  intraoperative  and  postoperative  settings,  intravenous  amiodarone  may  be  used  to  treat  a  variety  of  ventricular  and  supraventricular  arrhythmias.  It  may  be  used  to  convert  new-onset  atrial  fibrillation  into  sinus  rhythm.  In  addition,  the  advanced  cardiac  life  ...