TAILIEUCHUNG - Ebook Basic clinical anesthesia: Part 2
(BQ) Part 2 book “Basic clinical anesthesia” has contents: Cardiac anesthesia, vascular anesthesia, thoracic anesthesia, ambulatory anesthesia, hepatic and gastrointestinal diseases, endocrine diseases, pediatric anesthesia, the elderly patient, and other contents. | Part IV Specialty Anesthesia 26 Cardiac Anesthesia Mahesh Sardesai Cardiac anesthesiology encompasses the perioperative management of patients undergoing surgery on the heart and great vessels, as well as an increasing variety of transcatheter and other nonsurgical procedures. Cardiovascular disease is the leading cause of death in the United States and other industrialized nations, and it comprises an increasing share of the disease burden in the developing world. Accordingly, the fundamental principles of cardiac anesthesiology are essential not only for cardiac surgery itself, but also for the care of patients with various degrees of cardiovascular compromise undergoing noncardiac procedures. Therefore, optimum anesthetic care of these patients requires familiarity with cardiovascular physiology, diagnostic evaluation, transesophageal echocardiography (TEE), cardiopulmonary bypass (CPB), cardiac surgical techniques, and cardiac perioperative care. Cardiovascular Physiology The underlying principle of perioperative management in any patient is to maintain adequate oxygen delivery to sustain the metabolic requirements of vital organs and peripheral tissues. The ultimate goal of any cardiac surgical intervention is to provide conditions that promote adequate tissue perfusion with as little cardiopulmonary burden as possible. Blood Pressure Tissue perfusion depends on systemic blood pressure and local vascular resistance. Local vascular resistance is determined by local vasomotor tone. Systemic blood pressure, clinically measured with a noninvasive blood pressure cuff or an indwelling arterial catheter, is expressed as mean arterial pressure (MAP), M. Sardesai, ., . (*) Department of Anesthesiology, UPMC Shadyside Hospital, 5230 Centre Avenue Suite 205, Pittsburgh, PA 15232, USA e-mail: sardesaimp@ normally between 70 and 100 mmHg. normally between 70 and 100 mmHg. Pulsatile flow from cyclic cardiac contractions generates a pulse pressure,
đang nạp các trang xem trước
