Anesthetic Management in On-Pump Valvular Heart Surgery

There are many preoperative, intraoperative, and postoperative factors to be considered for patients undergoing on-pump cardiac valvular surgery. Preoperative considerations include a careful review of the patient’s medical history and preoperative studies; ascertainment of mechanism and severity of valvular dysfunction; physiologic compensation; and pathophysiologic sequelae. Intraoperative considerations include careful anesthetic induction with attention to hemodynamic goals; overall cardiovascular function; and functioning of the valve prosthesis or repaired native valve. Postoperative considerations include maintaining perfusion and oxygen delivery to vital organs, and managing postoperative bleeding. These considerations will be examined in more detail within this chapter.