Cardiac tamponade: anesthetic mgmt
Pretest
Question 1
True or False
All patients with cardiac tamponade should receive the following:
1.Oxygen
2. Volume expansion with blood, plasma, dextran, or isotonic sodium chloride solution, as necessary to maintain adequate intravascular volume
3. Bed rest with leg elevation: This may help increase venous return.
4. Positive-pressure mechanical ventilation
Keyword
Cardiac tamponade is a medical emergency. Preferably, patients should be monitored in an intensive care unit.
· All patients should receive the following:
· Oxygen
· Volume expansion with blood, plasma, dextran, or isotonic sodium chloride solution, as necessary to maintain adequate intravascular volume
· Bed rest with leg elevation: This may help increase venous return.
· Inotropic drugs (eg, dobutamine): These can be useful because they do not increase systemic vascular resistance while increasing cardiac output.
· Positive-pressure mechanical ventilation: This should be avoided because it may decrease venous return.
· Further medical care includes the following:
· Pericardiocentesis: Removal of pericardial fluid is the definitive therapy for tamponade.
· Emergency subxiphoid percutaneous drainage: This is a life-saving bedside procedure. The subxiphoid approach is extrapleural; hence, it is the safest for blind pericardiocentesis. A 16- or 18-gauge needle is inserted at an angle of 30-45° to the skin, near the left xiphocostal angle, aiming towards the left shoulder. When performed emergently, this procedure is associated with a reported mortality rate of approximately 4% and a complication rate of 17%.
· Echocardiographically guided pericardiocentesis (often performed in the cardiac catheterization laboratory): This is usually performed from the left intercostal space.
· First, mark the site of entry based on the area of maximal fluid accumulation closest to the transducer.
· Then, measure the distance from the skin to the pericardial space. The angle of the transducer should be the trajectory of the needle during the procedure.
· Avoid the inferior rib margin while advancing the needle to prevent neurovascular injury. Leave a 16-gauge catheter in place for continuous drainage.
· Percutaneous balloon pericardiotomy: This can be performed using an approach similar to that for echo-guided pericardiocentesis, in which the balloon is used to create a pericardial window.
· Treatment of the underlying cause to prevent recurrence
http://www.emedicine.com/med/topic283.htm
Post test
Question 1
True or False
All patients with cardiac tamponade should receive the following:
1.Oxygen
2. Volume expansion with blood, plasma, dextran, or isotonic sodium chloride solution, as necessary to maintain adequate intravascular volume.
3. Bed rest with leg elevation: This may help increase venous return.
4. Positive-pressure mechanical ventilation.
Answer:
TTTF
Positive-pressure mechanical ventilation should be avoided because it may decrease venous return.