Extreme caution with myocardial
depressant drugs. Conversely, myocardial hypertrophy may relatively
contraindicate drugs with positive inotropic actions, such as ketamine.
If muscle relaxants are required, rocuronium or cis-atracurium are the agents of choice.
Select agents that allow rapid recovery postoperatively. Myocardial
depressant drugs, such as barbiturates, propofol, halothane, enflurane, and
nitrous oxide, should be used with extreme care. Ketamine is contraindicated
in obstructive cardiomyopathy because of its inotropic and chronotropic
effects, but has been successfully used in congestive (non-obstructive) cardiomyopathy. Its effect of increasing secretions may also be undesirable.
Nondepolarizing muscle relaxants should be used with extreme care and only once the airway has been secured.
Suxamethonium is contraindicated because of risk of hyperkalemia and rhabdomyolysis. Opioids
should be used with caution because of their effects on respiratory