August 2025
| Hemodynamic goals | Avoid | Monitor | Intervention |
| Normal to fast HR (80 to 100 bpm) | Avoid bradycardia | 5-lead ECG Pulse oximetry with visible waveform | Management of bradycardia:
|
| Normal to low afterload | Avoid and/or immediately treat hypertension, targeting mean arterial pressure (or systolic/diastolic indices) rather than systolic pressure alone | Consider intra-arterial BP monitoring (particularly in patients who are unstable or undergoing cardiac surgery) | Prevent hypertension by providing adequate anesthetic depth and effective analgesia Treat hypertension with the use of vasodilators (including calcium channel blockers and sodium nitroprusside) Treat hypotension with careful titration of ephedrine |
| Normal to low preload | Avoid hypervolemia | Assess clinical response to small fluid boluses | Restrictive fluid management Intravenous nitroglycerin infusion and/or diuretics for volume overload |
| Maintain contractility | Avoid doses of drugs causing significant myocardial depression | Hemodynamics, including intra-arterial BP and cardiac output monitoring in unstable patients | If inotropic support is needed, infusion of milrinone or dobutamine is preferred. In patients with hypotension and low SVR, addition or substitution of low-dose epinephrine infusion may be necessary to maintain adequate BP. |
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