Section 1 Pre-anesthesia assessment and preparation
Pre-anesthesia assessment
Heart function classification
Preparation before anesthesia
Adjust cardiovascular therapy medications
antiplatelet drugs
Double Secret Bodhidharma (Pan Dingsheng)
Pre-anesthetic medication
anesthesia monitoring
TEE
Coagulation function monitoring
Section 2 Anesthesia for indirect cardiac surgery
Anesthesia for surgery for chronic constrictive pericarditis
Anesthesia for acute cardiac tamponade surgery
Anesthesia for ductus arteriosus ligation surgery
Pathophysiology
Left ventricular hypertrophy and dilation
Right ventricular hypertrophy and enlargement
Anesthetic treatment
Controlled blood pressure reduction before ligation
Right radial artery puncture pressure measurement
After the ductus arteriosus is closed, the blood volume is too large
To prevent postoperative hypertension, epidural anesthesia can be combined
Section 3 Anesthesia for open-heart surgery for congenital heart disease
Section 4 Anesthesia for Heart Valvular Disease Surgery
mitral stenosis
Pathophysiology
Main changes
Increased left atrial volume load
left ventricular hypofilling
The flow rate of blood through the mitral valve is related to the valve orifice area and valve pressure difference
When the mitral valve area is constant, the heart rate increases and the diastolic period shortens, which will seriously reduce left ventricular filling.
Chronic elevation of left atrial pressure increases pulmonary venous pressure and pulmonary blood volume
Difficulty adapting to fluctuations in lifting cycles and excessive fluid loads
Anesthetic treatment
General requirements
Pay attention to infusion and maintain appropriate blood volume
Avoid exacerbating existing pulmonary hypertension
Atrial fibrillation patients
Digitalis can be used until before surgery
New intraoperative atrial fibrillation
Increased ventricular rate in existing atrial fibrillation
Heart rate too fast
Preoperative
Not enough digitalis
Intravenous supplementation of low-dose digitalis
Sublingual nitroglycerin if necessary
Reduce pulmonary vascular pressure
Mitral valve insufficiency
Pathophysiology
Reflux flow
Influencing factors
Incompetent valve orifice area
left ventricular ejection time
Systolic mitral valve pressure
Positively related to peripheral resistance
ejection direction
Large systemic circulation resistance, large reflux, and small forward output
Chronic
Compensated eccentric left ventricular hypertrophy and enlargement
right ventricular overload
right ventricular failure
left ventricular dysfunction
acute
left atrial volume overload
Right ventricular overload
Anesthetic treatment
General requirements
Mild heart rate increase is beneficial
Maintain relatively low systemic circulatory resistance
Ensure adequate blood volume
Inotropes support left ventricular function
Anesthetic drug selection
Do not use drugs that increase systemic circulation resistance
Muscle relaxants
Hemodynamic factors should be considered
Combined use of vasodilators and inotropes
Monitoring
Invasive arterial blood pressure
left atrial pressure monitoring
After valve replacement
Acute person
Keep left atrial pressure low
Chronic person
Maintain high left atrial pressure
hypotension
Hypotension before cardiopulmonary bypass
Enhance myocardial contraction
aortic stenosis
Pathophysiology
Increased left ventricular end-diastolic pressure and volume
maintain sinus heart rate
Slow early and middle diastole
Dependent on late diastolic filling
Increased left atrial pressure
Pulmonary hypertension is rare
Angina pectoris
reason
Myocardial hypertrophy increases oxygen consumption
Increased wall pressure and insufficient perfusion
Hypertrophic myocardium reduces capillary density
Degree of stenosis & symptoms
Severe
Angina, syncope, difficulty breathing
Anesthetic treatment
General requirements
Maintain sinus rhythm and maintain effective circulatory capacity
Avoid tachycardia and increased afterload
Use vasodilators with caution
bradycardia
Bradycardia can cause CO to drop
hypotension
Symptomatic
Deoxygenated kidney infusion
High blood pressure (pulmonary hypertension)
Nitroglycerin
Does not cause a significant decrease in arterial pressure
monitor
floating catheter monitoring
causing ventricular arrhythmias
After valve replacement
Left ventricular pressure remains high
aortic valve insufficiency
Pathophysiology
Reflux
Influencing factors
mean diastolic pressure between aorta and left ventricle
left ventricular volume overload
Chronic
compensatory mechanism
Left ventricular enlargement and hypertrophy
Mild dilation of peripheral blood vessels
Does not affect left atrial function
acute
sudden left ventricular failure
Anesthetic treatment
General requirements
Avoid increasing afterload
Increase heart rate appropriately
Maintain adequate blood vessel capacity
Reduce vascular resistance
Acute person
Preoperative use of vasodilators
Intraoperative use of inotropes
monitor
Chronic patients
Good left ventricular compliance
Increased left atrial pressure occurs
After valve replacement
acute
Maintain normal left ventricular pressure
Chronic
Maintain high left ventricular pressure
Section 5 Anesthesia for coronary heart disease surgery
Anesthesia for arterial bypass grafting under extracorporeal pulmonary bypass
Section 6 Fast Track Cardiac Surgery Anesthesia
Section 7 Anesthesia for major vascular surgery
Section 8 Extracorporeal circulation
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