Anesthesia Management for Ischemic Heart Disease
The following things should be considered for the anesthetic management of Ischemic Heart Disease patients
- Preoperative Evaluation
- If the patient is on aspirin, it should be stopped 1 week before the surgery .
- Elective surgery should be postponed for 6 months
- Echocardiography has to be done to detect the Left Ventricular Ejection Fraction.
Monitoring of patient
- Pulmonary artery catheterization should be done if large intravascular fluid shifts are expected.
- Transesophageal Echocardiography is a useful method during assessment of intraoperative left ventricular function.
- ECG has to be done specially lead V5 (Which is best for diagnosing left ventricle infractions.
- All other investigation should be done .
Types of Anesthesia (Anesthesia management for IHD)
- General anesthesia is preferred over spinal anesthesia
- Among the spinal and epidural anesthesia, Epidural anesthesia is preferred because spinal is associated with the hypotension and maintenance of blood pressure is very important .
Benzodiazepines should be given a night before and on the day of surgery to make the patient calm.
- Drug of choice for induction in IHD patient is ETOMIDATEbut its not available so often ,so induction is done with the THIOPENTONE OR PROPOFOL (Propofol is also the drug of choice for the day care surgery).
- Cardiovascular response to laryngoscopy should be blunted by the opoids like fentanyl & local anesthetic agent lignocaine.
- Tachycardia should be prevented at any cost.
Maintenance of Anesthesia:
- Anesthesia is maintained by combining O2+N2O+Opoids
- Isoflurane can cause coronary steal .
- Inhalational agents decreases the cardiac output in the cardiac patients.
- Vecuroniumis the drug of choice for the muscle relaxation in cardiac patient.
- Vecuronium is the cardiac stable drug.
- HYOCAPNIAshould be avoided because it can cause coronary Vasoconstriction.
- Glycopyrolateis the drug of choice for the reversal along withNeostigmine.
- Tachycardia should be prevented in case of IHD patients so atropine should not be given along with the neostigmine.
Post operative care:
- IDH patients after surgery are very prone to myocardial infarction , the chances are high so proper care should be taken .