Hemodynamic goals | Avoid | Monitor | Intervention |
Sinus rhythm | Avoid atrial fibrillation or other SVT | 5-lead ECG | Manage new-onset atrial fibrillation or other SVT:
|
Normal HR (60 to 80 bpm) | Avoid tachycardia Avoid severe bradycardia Avoid junctional rhythm | 5-lead ECG Pulse oximetry with visible waveform | Design an anesthetic that maintains a relatively slow HR (eg, an opioid-based technique). Prevent tachycardia by ensuring adequate depth of anesthesia and analgesia. Manage tachycardia related to hypotension with a vasoconstrictor (eg, phenylephrine, norepinephrine) and fluid administration. Slow HR with beta blockers if necessary. |
Maintain afterload | Avoid hypotension | Intra-arterial BP | Administer a vasoconstrictor (eg, phenylephrine, norepinephrine) to manage hypotension. Consider preemptive administration of a low-dose infusion of a vasoconstrictor (eg, phenylephrine, norepinephrine) during induction. |
Maintain preload | Avoid hypovolemia | Assess clinical response to fluid boluses | Maintain intravascular volume status. Rapid resuscitation for hemorrhage. |
Maintain contractility | Avoid doses of drugs that cause significant myocardial depression | Hemodynamics | If inotropic support needed, norepinephrine is preferred. |
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