And Intravenous Anesthetics

Since the initial report by Murray et al. (29) on ischemic preconditioning of dog myocardium, there has been great interest in myocardial preconditioning with pharmacological agents. This includes myocardial preconditioning with volatile anesthetics such as desflurane (59), isoflurane (60,61), and sevoflurane (62) and intravenous opioid agonists (63,64). Pharmacological preconditioning is not limited to cardiac tissue only; other tissues, such as lungs, brain, and skeletal muscle (65), may benefit from preconditioning. In summary, preconditioning with anesthetics may offer life-extending benefits in cardiac vascular and organ transplantation surgical patients. (For more details on this topic, see Chapter 12.)

8. HEART TRANSPLANT

With the increasing numbers of successful heart transplants, anesthetic management of the patient after a heart transplant procedure requires special considerations. A transplanted heart is totally denervated and usually has a higher basal heart rate (90-110 beats/min); direct autonomic nervous system effects are mostly absent. Thus, agents such as atropine and glycopy-rrolate will not cause an increase in heart rate. Vagal stimulation maneuvers such as carotid massage and oculocardiac reflex are also minimized. However, acetylcholinesterase inhibitors such as neostigmine have been associated with severe brady-cardia. If bradycardia develops, administration of direct-acting cardiac agents such as isoproterenol or epinephrine may be required. The transplanted heart continues to respond to circulating catecholamines, and thus maintenance of cardiac output is aided by increased stroke volume (Frank-Starling relationship); maintaining adequate preload is considered essential in patients post-heart transplant. (See Chapter 10 for additional information.)

9. SUMMARY

With the aging population and an increase in health problems such as obesity, diabetes, and coronary artery diseases, perioperative management and anesthetic technique and medications that promote cardiovascular stability continue to offer challenges and new developments in the field of anesthesiol-ogy. These include new anesthesia medications, medical equipment and surgical technology, and anesthetic and surgical techniques. With further understanding of inhalational and intravenous anesthetics, maintaining stable, physiological cardiovascular function may be possible.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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