Wed3November0844PM 19

A 63-year-old patient with mitral regurgitation requires an emergency non-cardiac procedure under general anaesthesia.

Which of the following perioperative goals best applies?

(Please select 1 option)

Permissive hypercarbia

Heart rate 50-60 beats per minute

Minimise pre-load

Low-normal systemic vascular resistance Correct

Peak inspiratory pressures 35 cmH2O

Explanation

Mitral regurgitation leads to a proportion of blood ejected by the left ventricle flowing back into the left atrium, and therefore dilation of the left atrium and pulmonary hypertension.

Anaesthetic goals include:

Improve forward LV stroke volume and decrease regurgitant fraction. Vasodilatation can improve forward flow especially if pulmonary hypertension is a feature. Preload should be maintained or slightly increased. Decrease in afterload is beneficial as long as this is not suddenly reduced

Hypoxia, hypercarbia, and high inspiratory pressures can all worsen pulmonary hypertension, and should be avoided. A slightly increased heart rate is preferred, as this reduces time for regurgitation as well as reducing time for excessive left-ventricular filling. High afterload would increase the degree of regurgitation.

Reference:

Anaesthesia UK. Valvular Heart Disease.

Answer Statistics

1

1%

2

11%

3

13%

4

75%

5

2%

Times answered: 272