Research Article
Volume 6 Issue 8 - 2020
Perioperative Management of Patients with Heart Failure: A Review
Ana Isabel Pereira de Almeida1 and Humberto S Machado1,2*
1Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
2Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
*Corresponding Author: Humberto S Machado, Instituto de Ciências Biomédicas Abel Salazar and Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Received: November 06, 2019; Published: July 30, 2020




Abstract

Introduction: Heart failure is an end-stage clinical syndrome based on a broad variety of underlying cardiac conditions. These patients still have an unacceptably high morbidity and mortality when undergoing surgeries, not only cardiac but also non-cardiac surgeries. Therefore, special care is required to maximize safety before, during and after surgery.

This literature revision aims to carry out a systematic review of the perioperative management strategies for patients with heart failure and provides the reader with new insight in diagnosis and treatment of heart failure.

Methods: A literature review based on studies published between 2005 and 2018, available on PubMed and Google.

Results: In order to prevent perioperative complications, several practices are suggested.

Preoperative: Echocardiography is well established for the diagnosis of heart failure and is superior to risk scores and biomarkers in risk stratification; therapeutic optimization using β-blockers, ACEIs/ARBs and diuretics is indispensable; and surgeries should be postponed if adequate medical treatment has not been established or if evidence of preoperative acute heart failure.

Intraoperative: Transoesophageal echocardiography is the gold-standard for monitoring; inotropic and vasopressor agents have been recommended and used for several years if evidence of hypotensive acute heart failure, but they remain controversial; vasodilators, most commonly nitroglycerin, should be the predominant treatment in hypertensive acute heart failure patients; and normotensive patients generally require significant diuresis with intravenous loop diuretics.

Postoperative: Reach the patient's preoperative levels is wanted; echo and electrocardiography monitoring should be maintained; and avoiding known triggers of acute heart failure.

Conclusion: Recent advances in the field of cardiovascular anesthesiology have been achieved, however there are variations in the perioperative period approach, and even lack of agreement on some topics, evidencing the need for large trials to clarify them.

Keywords: Heart Failure; Systolic Dysfunction; Diastolic Dysfunction; Anesthesia; Perioperative Management

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Citation: Ana Isabel Pereira de Almeida and Humberto S Machado. “Perioperative Management of Patients with Heart Failure: A Review”. EC Anaesthesia 6.8 (2020): 10-32.

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