| Hemodynamic goals | Avoid | Monitor | Intervention |
| Sinus rhythm | - Avoid atrial fibrillation or other SVT
- Avoid loss of AV synchrony (eg, ventricular pacing or junctional rhythm)
| | Manage new-onset atrial fibrillation or other SVT: - Control HR
- Cardioversion of atrial fibrillation with hemodynamic compromise
Manage loss of AV synchrony: - Decrease dose of inhalation anesthetic while maintaining systemic BP (eg, with administration of phenylephrine, ephedrine, or norepinephrine)
|
| Normal HR (60 to 80 bpm) | - Avoid tachycardia
- Avoid severe bradycardia
- Avoid junctional rhythm
| - 5-lead ECG
- Pulse oximetry with visible waveform
| - Prevent tachycardia by ensuring adequate depth of anesthesia and analgesia
- Manage tachycardia related to hypotension with a vasoconstrictor (eg, phenylephrine, norepinephrine) and fluid administration
- Slow HR with beta blockers if necessary
|
| Maintain afterload | - Avoid hypotension
- Avoid sympathectomy (eg, spinal anesthesia)
- Avoid severe or persistent hypertension
| - Intra-arterial blood pressure for major surgical procedures
| Manage hypotension: - Administer a vasoconstrictor (eg, phenylephrine, norepinephrine) to manage hypotension
- Consider preemptive administration of a low-dose infusion of a vasoconstrictor (eg, phenylephrine, norepinephrine) during induction
Manage hypertension: - For hypertension with increased HR, administer a beta blocker (eg, metoprolol)
- Other antihypertensive agents may be titrated slowly in incremental doses if necessary
|
| Maintain preload | | - Assess clinical response to fluid boluses
| - Maintain intravascular volume status
- Rapid resuscitation for hemorrhage
|
| Maintain contractility | - Avoid doses of drugs that cause significant myocardial depression
| | - If continuous inotropic support is needed, norepinephrine is preferred
|
