Anesthesia w/ CV dz

Pts w/ CV dz will often have a low _____?

Cardiac reserve - cannot compensate if BP gets low during anesthesia

What is informed consent?

Vet discloses recommended dx and work up w/ risks and benefits so O can make an educated decision for care of pet

What is after load equivilant too?

Systemic vascular resistance

What is preload mean in a clinical sense?

volume in heart b/4 ejection

____ is often the beast measure of contractility during sx?

Systolic blood pressure (non-invasive not always very accurate)

If preload and after load increase you will see an ____ in contractility?

Increase

If HR increases you will see a ____ in contractility?

Decrease - less filling time

Name a few inotropic agents?

Doubutamine (Selective B agonist)

Dopamine (mixed)

NE (mixed A agonist)

What is going to affect Preload?

Venous return

Arterial pressure/ synchrony w/ ventricle

Compliance of ventricle

How do you clinically manage preload?

Maintain adequate intravascular volume

What does PVI/ dynamic measured volume response over 13 signify?

Pt will be fluid responsive

What is going to be representative of after load under anesthesia?

Diastolic bp

What is going to impact after load?

Arteriolar radius - shunting of blood

Viscosity of blood

How do we tx a low after load?

Vasoconstrictors

-Phenylephrine (selectie A agonist)

-NE (Mixed)

When would you want to postpone a procedure in a cardiac pt?

Signs of congestion

What effect does Acepromazine have on the heart?

Decrease SV and Cardiac output

Mild tachycardia

Anti-arythmic

Vasodilation

Vasodilation can be beneficial in what?

Forward flow in pts w/ mitral valve regeneration

ACE should be used in caution when a pt has ___?

Valve insufficiencies

Benzos have ___ CV affects and are considered ___?

Minimal - safe

Alpha 2 agonists are CI in what heart pts?

Valvular insufficient

Caution in: Pressure overload cardiomyopathies and fixed/ dynamic after load (Stenosis, HOCOM)

Opioids are considered ____ in CV pts but can cause _____?

Safte

Vagally mediated Bradycardia

What two opioids may cause hypotension via histamine release?

Morphine,

Meperidine

Propofol and alfaxon are considered ____ in CV pts but should NOT be given to _____ pt?

Safe

Hypovolemic

Why do we use ketamine cautiously in pt w/ CV dz?

Negative Cardiac inotropic effect and increases o2 requirements

possible to induce arrhythmias

What is the most safe induction agent for a CV pt?

Etomidate

What CV pts should etomidate be used with caution?

Decreased LV function

- DCM

- Stage C MMVD

What is going to be a best maintenance drug for CV pts?

TIVA - more stable but unable to change depth as fast

(Inhalants cause dose dependent CV dysfunction)

What should we do for systolic dysfunction?

Judicious fluid therapy 3ml/kg/hr to promote forward flow

Dobutimide - hypotension therapy

Prevent bradycardia/ tx aggressively

W/ systolic dysfunction you want to have a ____ heart right?

High normal - reduces regurgitant flow

What are clinical tx of Diastolic dysfunction?

5ml/kg/hr unless congested

NE/ Phenylephrine -vasopressors

Maintain low normal HR

Anticholinergics should be used with ____?

Caution

We want to avoid what diastolic dysfunction?

Prevent decrease in after load

Brady-/tachycardia

What are goals of anesthesia w/ mitral valve dz?

Reduce after load and maintain contractility w/ judicious fluid therapy and keep a high normal HR

What is anesthesia management of a pt w/ Mitral valve dz?

Opioid +/- Alfaxan / low dose ACE

PIVA/TIVA for maintenance

Dobutamine prepared b4 induction

What are the goals of anesthesia w/ DCM?

maintain contractility - inotrops

Maintain preload w/ fluid therapy

HAVE Antiarrhythmic plan

Why is DCM so difficult to maintain contractility?

Downregulated B receptors - need more drug

What is anesthesia management for DCM?

Pre-med - opioid +/- alfaxan

Induction - propofol / alfaxaon (careful w/ etomidate)

Inotrope pulled up in case

How should DCM induced Afib be tx?

Resynchronization w/ ventricle or poss fentanyl to reduce AV nodal conduction

-Avoid anticholinergics

How should DCM induced ventricular arrhythmia be tx?

B-blockers

Esmolol

Lidocaine

Procanimide

What is the goal of anesthesia w/ a PDA?

Maintain SV so that shunting does not switch direction

What is drug anesthesia protocol for PDA?

Opioid +/- alfaxan

Induction - propofol, alfaxan or etomidate

Inotrope and vasopressor pre-prepared

How should a pt w/ PDA be monitored?

SPO2 on cranial and caudal aspect of the body

What is drug do we avoid for premed of Subaortic/ pulmonic stenosis?

Ace

-can use alfaxan, deemed, or opioids

What drug should be avoided for an induction agent w/ Subaortic/ pulmonic stenosis?

kETAMINE

What should be prepared prior to induction of Subaortic/ pulmonic stenosis?

Vasopressors - NE/ phenlephrine - must aggressively tx any hypotension

What is anesthesia maintenance for Subaortic/ pulmonic stenosis?

Fluids at 5ml/kg/hr

Should have diltazem ready

What should be done differently w/ HCM and Subaortic/ pulmonic stenosis?

Fluid rate should be reduced to 3ml/kg/hr