RT Book, Section
A1 Sharma, Sonal
A1 Durieux, Marcel E.
A2 Johnson, Ken B.
SR Print(0)
ID 1103964564
T1 Anesthetic Implications of Poor Cardiac Function
T2 Clinical Pharmacology for Anesthesiology
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071736169
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1103964564
RD 2024/04/23
AB Heart  failure  is  increasingly  being  recognized  as  a  growing  health  problem  worldwide.  It  is  estimated  that  the  lifetime  risk  of  developing  heart  failure  is  approximately  20%  for  patients  older  than  40  years.1  Clinical  anesthesiologists  can  therefore  expect  to  see  cases  involving  patients  suffering  from  heart  failure  with  increasing  frequency.  Symptomatic  heart  failure  is  associated  with  high  risk  of  morbidity  and  mortality  as  a  result  of  perioperative  ischemia/infarction,  dysrhythmias,  worsening  heart  failure,  postoperative  cognitive  dysfunction,  and  stroke.2,3  Asymptomatic  left  ventricular  dysfunction,  which  is  considered  a  precursor  of  symptomatic  heart  failure  and  is  assumed  to  have  similar  prevalence  as  symptomatic  heart  failure,  is  also  associated  with  high  perioperative  mortality.4  Since  most  anesthetics  interfere  with  cardiovascular  performance,  either  by  direct  myocardial  depression  or  by  depression  of  sympathetic  activity,  on  which  these  patients  rely,  an  appropriate  anesthetic  technique  must  be  selected  to  minimize  hemodynamic  changes  and  maintain  a  near-normal  physiologic  status.  This  chapter  discusses  the  aspects  of  dose  reduction,  titration  of  drugs,  and  the  pharmacodynamic  effects  of  each  class  of  anesthetic  drugs.  As  an  example,  the  chapter  provides  a  practical  guide  to  the  selection  and  use  of  general  anesthetic  agents  in  patients  with  poor  cardiac  function  undergoing  colectomy  and  discusses  the  pharmacologic  management  of  acute  cardiac  deterioration.