Difference between revisions of "Aortic regurgitation"
From WikiAnesthesia
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=== Preoperative optimization<!-- Describe how this comorbidity may influence preoperative evaluation and optimization of patients. --> === | === Preoperative optimization<!-- Describe how this comorbidity may influence preoperative evaluation and optimization of patients. --> === | ||
* Increased risk of perioperative cardiovascular decompensation | * Increased risk of perioperative cardiovascular decompensation<ref>{{Citation|title=Copyright|date=2008|url=http://dx.doi.org/10.1016/b978-1-4160-3998-3.50002-5|work=Stoelting's Anesthesia and Co-Existing Disease|pages=iv|publisher=Elsevier|access-date=2021-12-03}}</ref> | ||
=== Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. --> === | === Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. --> === | ||
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** RV failure > pulmonary HTN | ** RV failure > pulmonary HTN | ||
* In acute AI, sudden increase in LV volume can induce cardiogenic shock and pulmonary edema | * In acute AI, sudden increase in LV volume can induce cardiogenic shock and pulmonary edema | ||
** Sudden AI that does not allow time for compensatory LV dilation can result in acute pulmonary congestion | |||
== Signs and symptoms<!-- Describe the signs and symptoms of this comorbidity. --> == | == Signs and symptoms<!-- Describe the signs and symptoms of this comorbidity. --> == | ||
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* Diuretics, anticoagulants | * Diuretics, anticoagulants | ||
* Immediate management of acute AI involves afterload reduction (nitroprusside) & augmentation of contractility & rate (dobutamine) | |||
=== Surgery<!-- Describe surgical procedures used to treat this comorbidity. --> === | === Surgery<!-- Describe surgical procedures used to treat this comorbidity. --> === | ||
* Severe acute AI may require emergency AV repair/replacement | |||
* Note that intra-aortic balloon pump is '''contraindicated''' | |||
=== Prognosis<!-- Describe the prognosis of this comorbidity --> === | === Prognosis<!-- Describe the prognosis of this comorbidity --> === | ||
Revision as of 07:11, 3 December 2021
Aortic regurgitation
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| Anesthetic management |
{{{anesthetic_management}}} |
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| Signs and symptoms | |
| Diagnosis | |
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Provide a brief summary of this comorbidity here.
Anesthetic implications
Preoperative optimization
- Increased risk of perioperative cardiovascular decompensation[1]
Intraoperative management
- Hemodynamic goals are to maintain forward flow and decrease regurgitant volume
- Preload: normal-high to augment CO
- Afterload: low-normal to promote forward flow
- Rate: high-normal
- Rhythm: sinus (rate more important)
- Contractility: high-normal
Postoperative management
Related surgical procedures
Pathophysiology
- Hemodynamic sequelae of AI:
- LA distension > Volume overload > Subendothelial ischemia
- CHF > pulmonary edema
- RV failure > pulmonary HTN
- In acute AI, sudden increase in LV volume can induce cardiogenic shock and pulmonary edema
- Sudden AI that does not allow time for compensatory LV dilation can result in acute pulmonary congestion
Signs and symptoms
Diagnosis
Treatment
Medication
- Diuretics, anticoagulants
- Immediate management of acute AI involves afterload reduction (nitroprusside) & augmentation of contractility & rate (dobutamine)
Surgery
- Severe acute AI may require emergency AV repair/replacement
- Note that intra-aortic balloon pump is contraindicated
Prognosis
Epidemiology
References
- ↑ "Copyright", Stoelting's Anesthesia and Co-Existing Disease, Elsevier, pp. iv, 2008, retrieved 2021-12-03
Top contributors: Olivia Sutton and Chris Rishel