Anesthesia in Patients with Heart Disease

Anesthesia for the patient with heart disease has become increasingly safer with the passage of years due to a better knowledge of the physiology of heart disease and of the pharmacologic action of anesthetic agents themselves. There are few statistics to support the clinical impression that patients with cardiac disease tolerate anesthesia and surgery well but reports are not lacking. The difficulty in gathering statistics lies in an inability to compare results in comparable groups of patients. Anesthesia is but a small part of the total operative experience. The patient with serious heart disease usually undergoes a relatively long period of preoperative preparation. When ready, he is given preanesthetic medication and is subjected to the administration of an anesthetic. The surgical operation is superimposed on these preliminary events. Subsequently, convalescence with its many physiologic adjustments completes the surgical experience. Anesthetic problems may originate in any of the aforementioned phases of the operative experience. These problems have been briefly reviewed. The most important factor in minimizing the problems of anesthesia itself is the skill and knowledge with which the anesthetic agents are chosen and administered rather than the actual pharmacologic and physiologic effects of the agents themselves. On a background of thorough medical preperation safe anesthesia for the patient with heart disease consists of the careful selection of preanesthetic medication, flawless technic, and use of minimal quantities of anesthetic agents and adjuncts. Despite the attainment of these goals, circulatory and respiratory problems will be encountered. These may be related to the heart disease itself, to medical preparation, pharmacologic side effects, and to a multitude of undesirable respiratory and circulatory reflexes. The latter in turn reside in anesthetic and surgical manipulation. Knowledge of these factors enables the internist to understand the problems of anesthesia and to prepare the patient for the operative experience.