Only a minority of HCM patients is brought to surgery for myectomy and/or mitral valve replacement. Many patients will nonetheless require anesthesia at some point for noncardiac surgery. Management is directed at minimizing the degree of outflow obstruction, lessening the impact of diastolic dysfunction, and controlling arrhythmias. Both general and neuraxial anesthesia techniques can produce wide swings in hemodynamics. As mentioned, during anesthesia induction in the patient with a fixed obstruction to systolic ejection, such as aortic stenosis, it often becomes necessary to administer fluids and vasoconstrictors to prevent hemodynamic instability. In the patient with dynamic obstruction, the greater the decrease in venous return the worse the degree of obstruction. Agents, which decrease sympathetic tone and peripheral vascular resistance, likewise can increase the degree of dynamic obstruction, as the heart is free to contract against less resistance. An increase in heart rate associated with laryngoscopy, intubation, and surgical stimulation should be avoided, as this will decrease the time of LV diastolic filling and systolic ejection resulting in worsening of the degree of dynamic obstruction and hypotension. Consequently, these patients are frequently managed with fluid and vasopressor administration at the time of induction and intraoperative arterial and TEE monitoring. Short-acting beta-blockers such as esmolol can be used to reduce myocardial contractility, decrease the heart rate, and counteract the effects of increased catecholamine release during intubation, emergence, and other periods associated with surgical stress.