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Table 1 The interactions between surgical procccedure, preexsisting cardiac diseases, and the anesthesiolohgist’s role

From: Anesthetic challenges of patients with cardiac comorbidities undergoing major urologic surgery

Clinical situations Pathophysiology mechanisms Clinical impact on cardiac function Anesthesiologist’s role
Bleeding hypovolemia Hypovolemia, hypotension New myocardial ischemia episode Preoperative optimisation
Tachycardia Decompensated heart failure Cross matched blood units
Reduced venous return Myocardial infarction Large bore veins
Decreased stroke volume Severe arrhythmias Central vein
Decreased cardiac output Invasive blood pressure monitoring
Futher hypotension Rapid liquids administration devices
Anemia induced moycardial hypocontractility Cell salvage
Vazopressors
Thromboelastography
Thrombus migration Sudden increased right ventricular afterload Deteriorate right ventricular infarction ETCO2 monitoring
Right infarction Global heart failure PEEP
Hypoxemia
Arrhythmias Cardiac arrest Transesocardiography
Aspiration from central catheter
Open PNX Hypoxemia Decompensate preexsiting cardiac and respiratory diseases Strict comunication with surgeon
Impaired contractility
Manual ventilation till pleura clossure
Postoperative X-ray
Position (lateral decubitus) Reduced venous return Deteriorate cardiac function Reduce PEEP level
Hypovolemia correction
Large bore veins
Central vein
Invasive blood pressure monitoring
Metabolic changes Decreased cardiac output Metabolic acidosis Careful monitoring
Drug induced diarrea
Loss of bicarbonates Impaired cardiac contractility Preoperative correction
Hyper/hyponatremia Respiratory alchalosis Enteral/parenteral nutrition
Hyper/hypokalemia Arrhythmia
Hyper/hypochloremia
  1. PNX-Pneumothorax, ETCO2-EndTidalCO2, PEEP-Positive End Expiratory Pressure.