The whole idea is to maintain forward stroke volume to maintain coronary and vital organ perfusion. So
1. Minimize SVR: Avoid direct alpha one agonists which increases SVR , Increased SVR will move blood into LA rather than to forward flow.
2. Maintain Preload
3. Maintain HR towards high normal side as high heart rate decreases diastolic time and reduces regurgitation cach.
4.In patients with coexisting pulmonary hypertension avoid increases in airway pressures.
5. Co existing AF is common so the patient may be on oral coagulants prior to surgery.
So use Ephedrine over phenylephrine for hypotension with normal heart rate
Prefer Inotropes with predominantly B1 action like epinephrine as they will maintain heart rate without increasing SVR. Milrinone, Levosimendan are good choices.
1. Minimize SVR: Avoid direct alpha one agonists which increases SVR , Increased SVR will move blood into LA rather than to forward flow.
2. Maintain Preload
3. Maintain HR towards high normal side as high heart rate decreases diastolic time and reduces regurgitation cach.
4.In patients with coexisting pulmonary hypertension avoid increases in airway pressures.
5. Co existing AF is common so the patient may be on oral coagulants prior to surgery.
So use Ephedrine over phenylephrine for hypotension with normal heart rate
Prefer Inotropes with predominantly B1 action like epinephrine as they will maintain heart rate without increasing SVR. Milrinone, Levosimendan are good choices.
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