Hemodynamic goals | Avoid | Monitor | Intervention |
Normal to fast HR (80 to 100 bpm) | Avoid bradycardia | 5-lead ECG Pulse oximetry with visible waveform | Management of bradycardia:
|
Normal to low afterload | Avoid and/or immediately treat hypertension | Intra-arterial blood pressure (particularly MAP) | Prevent hypertension by continuing chronically administered antihypertensive medications, providing adequate anesthetic depth and effective analgesia If necessary, a vasodilator (eg, calcium channel blocker, nitroprusside) may be infused to decrease MAP and SVR If necessary, treat significant hypotension with careful titration of ephedrine Since patients with aortic regurgitation commonly have a wide pulse pressure, it is important to target control of the MAP rather than the systolic blood pressure |
Normal to low preload | Avoid hypervolemia | Assess clinical response to small fluid boluses | Restrictive fluid management Intravenous nitroglycerin infusion for volume overload |
Maintain contractility | Avoid doses of drugs that cause significant myocardial depression | Hemodynamics | If inotropic support is needed, milrinone, dobutamine, or low-dose epinephrine is preferred |
Do you want to add Medilib to your home screen?