Key points for anesthetic and hemodynamic management of aortic or mitral regurgitation during cardiac surgery

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: Ephedrine. Glycopyrrolate if necessary. Low-dose infusion of dopamine or epinephrine if necessary.
Normal to low afterload	Avoid hypertension	Intra-arterial BP	Prevent hypertension by providing adequate anesthetic depth and effective analgesia. Treat hypotension with careful titration of ephedrine.
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.

HR: heart rate; bpm: beats per minute; ECG: electrocardiogram; BP: blood pressure.

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