Version June 2024
| Hemodynamic goals | Avoid | Monitor | Intervention |
| Sinus rhythm | Avoid atrial fibrillation Avoid tachyarrhythmias | 5-lead ECG | Manage without delay new-onset atrial fibrillation or other SVT:
|
| Slow to normal HR (50 to 70 bpm) | Avoid tachycardia Avoid severe bradycardia | 5-lead ECG Pulse oximetry with visible waveform | Prevent pain-induced tachycardia by ensuring adequate anesthetic depth and effective analgesia. Design an anesthetic that maintains a relatively slow HR (eg, an opioid-based technique) and induce anesthesia slowly. Manage tachycardia related to hypotension with phenylephrine (or norepinephrine). Slow HR with beta blockers if necessary. |
| Maintain afterload | Avoid hypotension | Intra-arterial BP | Administer a vasoconstrictor (eg, phenylephrine, norepinephrine) to manage hypotension. |
| Adequate preload | Avoid hypervolemia | Clinical course and oxygenation Development of flash pulmonary edema | Management of pulmonary edema:
|
| 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) Arterial blood gas analysis | Minimize risk of hypoxemia and hypercarbia by:
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