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KMID : 1033820000010010019
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Journal of Artificial Heart Research
2000 Volume.1 No. 1 p.19 ~ p.30
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Anesthetic management of end-stage heart failure
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Lee Hye-Won
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Abstract
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The uneventful procedure of surgery and anesthesia for those who have normal cardiac function may lead to serious consequences in the patients with end-stage heart failure. Successful management of anesthesia and life support for patients undergoing surgery requires the same knowledge and skill as any other type of surgery plus a detailed understanding of cardiac disease, the current functional status of the patient’s cardiovascular system, and the special requirements of the intended surgery. It may be beneficial to order the first daily dose of other drugs taken routinely by the patient. For patients with impaired ventricular function at rest and minimal cardiac reserve, lesser amounts of preanesthetic medication are usually sufficient. Various techniques are all compatible with the pathophysiology of end-stage heart disease. For example, a combination of etomidate 0.3 mg/kg + fentanyl 10mg/kg + succinylcholine 1.5mg/kg IV will rapidly produce acceptable intubating conditions without cardiovascular depression. Anesthesia can then be maintained with supplemental fentanyl (35 to 75mg/kg total) + scopolamine (0.3mg) or a benzodiazepine as tolerated. An important principle to remember is that the hemodynamic responses to most anesthetic drugs are dose-related. To provide satisfactory anesthetic conditions for both patient and surgeon and to maintain optimal cardiovascular function, all details of the anesthetic plan must be carefully considered.
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KEYWORD
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end-stage heart failure, preanesthetic medication, anesthetic drugs
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