Afterload reduction and preload augmentation improve the anesthetic management of patients with cardiac failure and valvular regurgitation.
Data were collected from 17 patients with valvular regurgitation and ventricular failure who were about to undergo prosthetic replacement of an insufficient cardiac valve. Awake control hemodynamic measurements revealed that these patients came to the operating room with a high systemic vascular resistance of 38 units and low cardiac and stroke volume indices of 2.2 L/min/m2 and 30 ml/beat/m2, respectively. A preanesthetic infusion of nitroprusside together with almost 2 L of lactated Ringer's solution caused vascular resistance to decrease to 19 units (normal) while filling pressure remained high. As a result, while the combined therapy continued, neither the induction of anesthesia nor surgical stimulation produced cardiovascular deterioration; in fact, cardiac index measured above 3.1 L/min/m2 and stroke volume index above 40 ml/beat/m2 throughout anesthesia and surgery. We conclude, therefore, that the combination of afterload reduction and preload augmentation provides the best possible environment within which to conduct the anesthetic management of patients with valvular regurgitation and ventricular failure.
D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000379:methods*; D005292:Ferricyanides / Q000627:therapeutic use*; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery*; D006349:Heart Valve Diseases / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008875:Middle Aged; D009599:Nitroprusside / Q000627:therapeutic use*; D013318:Stroke Volume / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects
D005292:Ferricyanides; D009599:Nitroprusside