Anesthetic challenges of patients with cardiac comorbidities undergoing major urologic surgery

Domi, Rudin; Sula, Hektor; Ohri, Ilir; Beqiri, Arben; Kaci, Myzafer; Bodeci, Artan; Laho, Haki

doi:10.1186/1755-7682-7-17

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	Global heart failure	PEEP
	Arrhythmias	Cardiac arrest	Transesocardiography
	Arrhythmias	Cardiac arrest	Aspiration from central catheter
Open PNX	Hypoxemia	Decompensate preexsiting cardiac and respiratory diseases	Strict comunication with surgeon
	Impaired contractility		Strict comunication with surgeon
			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	Metabolic acidosis	Careful monitoring
	Loss of bicarbonates	Impaired cardiac contractility	Preoperative correction
	Hyper/hyponatremia	Respiratory alchalosis	Enteral/parenteral nutrition
	Hyper/hypokalemia	Arrhythmia
	Hyper/hypochloremia	Arrhythmia

PNX-Pneumothorax, ETCO2-EndTidalCO2, PEEP-Positive End Expiratory Pressure.

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