Classically neuraxial anaesthesia is avoided in severe aortic stenosis: Causes reduction in SVR and thus systemic hypotension Fixed obstruction impedes compensatory increase in cardiac output Can result in spiral of decreased coronary perfusion, ischaemia, further...
Symptomatic Patients Asymptomatic Patients Candidate for valve replacement Not a candidate for valve replacement Low to intermediate risk surgery High-risk surgery Valve replacement should be considered before surgery Non-cardiac surgery should be performed only if is...
Location & Review HDU / ICU for ongoing BP monitoring: NCEPOD recommends admission for valve area <1cm2 Should be strongly considered if reduced systolic function Monitoring & Investigations Monitor for renal dysfunction Analgesia Avoid NSAIDS –...
Choice Spinal anaesthesia is traditionally avoided: Potential for hypotension and vasodilation caused by the rapid onset of sympathetic blockade Decreased preload and decrease in cardiac output Decrease in afterload and coronary filling Cases of carefully titrated...
Significant risk of MI and death Compensatory mechanisms for fixed output state disrupted by anaesthesia Anaesthesia induces a reduction in SVR Fixed obstruction in AS impedes compensatory increase in cardiac output Resulting hypotension can lead to reduced myocardial...
