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• W1983221809 abstract "Patients with pre-existing left ventricular failure undergoing surgery and those who develop left ventricular failure subsequent to anaesthesia and surgery are at risk of perioperative cardiac death and, consequently, represent a challenging task to all involved in their perioperative care. Perioperative left ventricular failure encompasses a broad spectrum of abnormalities in left ventricular function, ranging from asymptomatic dysfunction, through cardiogenic pulmonary oedema and low cardiac output syndrome, to cardiogenic shock. The prevention and treatment of perioperative left ventricular failure requires a proper understanding of the regulation of cardiac output and venous return and of the complex interplay of the determinants of left ventricular function. The haemodynamic management must be based on close monitoring of both left ventricular function and global and regional haemodynamic performance. The existing data are then used to assess the actual structural and functional abnormalities of the cardiovascular system, to choose appropriate therapy and to evaluate its efficacy continuously. The understanding and application of the pathophysiological concepts such as systolic and diastolic left ventricular failure, afterload mismatch, left ventricular remodelling and stunning can be helpful for evaluation of the failing left ventricle. The treatment of perioperative left ventricular failure is primarily based on optimizing oxygenation of the arterial blood, heart rate, effective blood volume and left ventricular preload. This goal can be usually achieved by means of supplementary oxygen, positive airway pressure breathing or ventilation, analgesia and sedation, pacing or electroconversion of tachyarrhymias, and the use of diuretics and vasodilators. The next step is the enhancement of myocardial contractility with positive inotropic agents and restoration of an adequate arterial pressure. Because in severe perioperative left ventricular failure the efficacy of pharmacological interventions can reach their limits, the addition of mechanical circulatory support must be considered whenever indicated." @default.
• W1983221809 created "2016-06-24" @default.
• W1983221809 creator A5066922591 @default.
• W1983221809 date "1994-03-01" @default.
• W1983221809 modified "2023-10-09" @default.
• W1983221809 title "Perioperative left ventricular failure: the rationale for use of vasoactive drugs" @default.
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• W1983221809 doi "https://doi.org/10.1016/s0950-3501(05)80145-x" @default.
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