Version June 2024
| Hemodynamic goals | Avoid | Monitor | Intervention |
| Sinus rhythm | Avoid atrial fibrillation or other SVT | 5-lead ECG | Manage new-onset atrial fibrillation or other SVT:
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| Slow to normal HR (50 to 70 bpm) | Avoid tachycardia Avoid severe bradycardia <50 bpm | 5-lead ECG Pulse oximetry with visible waveform | Prevent pain-induced tachycardia by ensuring adequate anesthetic depth and effective analgesia Manage tachycardia related to hypotension with phenylephrine (or norepinephrine) Decrease HR with beta blockers if necessary |
| Maintain afterload | Avoid hypotension Avoid sympathectomy (eg, spinal anesthesia) | Intra-arterial BP for major surgical procedures | Administer a vasoconstrictor (eg, phenylephrine, norepinephrine) to manage hypotension |
| Adequate preload | Avoid hypervolemia | Clinical course and oxygenation Development of flash pulmonary edema (may present as acute coughing and hypoxemia in an awake patient) | Management of pulmonary edema: treat hypoxemia related to pulmonary edema immediately with 100% oxygen, PEEP, and, if necessary, intubation and controlled ventilation |
| Avoid hypovolemia | Assess clinical response to fluid boluses | Maintain intravascular volume status Rapid resuscitation for hemorrhage | |
| Maintain RV contractility | Avoid doses of drugs that cause significant myocardial depression | Hemodynamics | If inotropic support is needed, milrinone or dobutamine may be used if SVR and systemic BP are maintained; low-dose epinephrine may be necessary |
| Minimize PVR (optimize oxygenation and ventilation) | Avoid hypoxemia Avoid hypercarbia | Pulse oximetry with visible waveform Capnometry (end-tidal CO2) ABG analysis if an intra-arterial catheter is in place | Minimize risk of hypoxemia and hypercarbia by:
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