In patients with severe cardiac disease, carefully titrate IV fluids to avoid inducing congestive heart failure from fluid overload. Patients will vary in how much fluid and at what rate they can tolerate. Guide fluid administration by monitoring any of the following: systemic blood pressure, central venous pressure, oxygenation, or auscultation of lung sounds.
Preoperatively evaluate cardiac arrhythmias for consideration of perianesthetic treatment. Cardiac medications should be administered normally the day of surgery. Some medications may potentiate hypotension (e.g., angiotensin-converting enzyme inhibitors and β blockers). Be prepared to administer inotropes or other supportive measures if needed.14
Opioid analgesics are useful during anesthesia of the patient with cardiovascular compromise. Certain anesthetic medications may be less appropriate in some types of cardiac disease (e.g., at higher doses, ketamine may increase heart rate, which could be a problem in patients with hypertrophic cardiomyopathy; avoid α-2 agonists in dogs with mitral valve disease).15 A multimodal approach using drugs from multiple pharmacologic categories is preferred to minimize extreme cardiovascular effects of any one drug.16