Anesthesia for cardiac patients

Which management priority best maintains the myocardial supply–demand balance in ischemic heart disease during anesthesia?

• Allowing tachycardia to sustain cardiac output

• Minimizing vasodilators to preserve afterload

• Using deeper anesthesia or adrenergic blockade to control autonomic increases in heart rate and blood pressure

• Avoiding all beta-blockers perioperatively

On the morning of elective surgery, which antihypertensive management strategy is most appropriate?

• Withhold all antihypertensive drugs to avoid intraoperative hypotension.

• Continue most antihypertensive therapy up to surgery; consider withholding ACE inhibitors and ARBs due to increased intraoperative hypotension risk.

• Switch all patients to parenteral vasodilators the night before surgery.

• Double the dose of ACE inhibitors and ARBs to prevent perioperative hypertension.

Which statement about the transplanted heart during anesthesia is most accurate?

• It retains normal autonomic reflexes, making indirect vasopressors highly effective

• It is totally denervated; reflex tachycardia is absent and direct-acting agents are preferred over indirect vasopressors

• It responds strongly to ephedrine due to robust catecholamine stores

• Rapid vasodilation is well tolerated because of preserved baroreflexes

A patient scheduled for noncardiac surgery has poor or unknown functional capacity (<4 METs). You judge that further testing will change perioperative decision-making. Based on the algorithm, which step is recommended next?

• Proceed directly to surgery

• Initiate coronary revascularization immediately

• Order pharmacologic stress testing (Class IIa)

• No further testing (Class III: No Benefit)

Which pre-intubation technique is specifically listed to attenuate the hypertensive response in hypertensive patients during airway manipulation?

• Administering ketamine for its analgesic effect

• Deepening anesthesia with a potent volatile agent

• Avoiding opioids to prevent respiratory depression

• Doubling the dose of muscle relaxant

Which intravenous agent is particularly useful for controlling postoperative hypertension accompanied by tachycardia, and should be considered in the recovery period when contributing causes have been corrected?

• Labetalol

• Hydralazine

• Nitroglycerin

• Esmolol

Which of the following surgeries carries the highest cardiovascular risk?

• Emergency appendectomy

• Carotid endarterectomy

• Femoral–popliteal bypass surgery

• Inguinal hernia repair

A 67-year-old patient with uncontrolled hypertension presents for an elective dialysis access creation. Which of the following techniques is not suited for attenuating the hypertensive response to intubation?

• Administering 3 μg/kg of fentanyl intravenously

• Administering topical airway anesthesia

• Administering lidocaine 0.5 mg/kg intravenously

• Administering esmolol 1 mg/kg intravenously

A 24-year-old female patient with a preoperative QTc interval of 550 ms is undergoing breast surgery under general anesthesia. Droperidol is administered to the patient for prevention of postoperative nausea, following which the patient goes into polymorphic-ventricular tachycardia. Which of the following drugs/therapies is best for the patient at this point?

• Amiodarone

• Lidocaine

• magnesium

• Diltiazem

Surgical electrocautery may cause a problem with an automated implantable cardioverter defibrillator (AICD) by all the following mechanisms, except

• AICD interpreting a cautery current as ventricular fibrillation

• Inhibition of pacemaker function due to cautery artifact

• Increased pacing rate due to activation of a rate-responsive sensor

• Cautery current generating too much heat at the location of AICD and

  causing burns