Anesthesia and the Cardiac Patient麻醉和心脏病患者

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1、PharmacologicConsiderationsintheCardiacPatientWayneE.Ellis,Ph.D.,CRNA8/13/2021TreatmentofIschemia(primary)ASA325mgimmediatelyThrombolytics(Retevase)>flowratethanTPA2doses@30minintervalslyseclotsthroughtheactivationofplasminogen8/13/2021PrimaryTreatmentAntiplateletagents(abciximab,eptifibati

2、de,tirofiban,integullin)GPIIb-IIIaantagonistsinhibitplateletfunctionbyblockingtheGPIIb-IIIareceptor,thefinalpathwayofplateletaggregationtherebydecreasingthrombidevelopmentandpreventsarterialvesselocclusion8/13/2021PercutaneousCoronaryInterventionAdvantagesinclude:higherrecanulazationratesim

3、provedbloodflowthroughtheinfarct-relatedvesselimprovedLVfunctionlowerin-hospitalmortalityratesAnestheticTechniqueGoalsofAnesthesialossofconsciousnessamnesiaanalgesiasuppressionofreflexes(endocrineandautonomic)musclerelaxationPreoperativePreparationAnginaMedicationstocontrolitBloodpressureco

4、ntrolledDiastolic<95torrCongestiveheartfailuretreatedDiureticsAfterloadreductionBedrestifindicatedControldiabetesPreoperativeMedicationsSedationPreventtachycardiaHypertensionPreparedforhypoxiaSupplementaloxygenCalciumchannelblockersnotprotectiveofperioperativeischemiaAntihypertensivescontin

5、ueondayofsurgeryStopDiuretics8/13/2021LowMolecularWeightHeparinEnoxaparin,DalteparinAnticoagulantactivitybybindingtoantithrombinIII,whichfurtherbindsandinactivatesthecoagulationfactorsIIa(thrombin)andXaAdvantagesincludedosedperbodywt.Givenq12subq.Lesstrombocytopeniaandbleeding8/13/2021Opioi

6、dsAdvantagerelatestotherelativelackofmyocardialdepressionExceptionSufenta,Carfentanil,andhighdosefentanylTheymaintainstablehemodynamicsandreduceheartrateAprimaryopioidtechniquemaybeofvalueinthepatientwithseveremyocardialdysfunctionOpioidsAdvantagesExcellentanalgesiaHemodynamicstabilityBlunt

7、reflexesCanuse100%oxygenOpioidsDisadvantagesMaynotblockhemodynamicandhormonalresponsesinpatientswithgoodLVfunctionDonotensureamnesiaChestwallrigidityRespiratorydepression8/13/2021Vasoconstrictorsareusefulinthepreventionandtreatmentofischemiar/ttheability