Anesthesia for patients with ischemic heart disease

The suggested anesthetic management of patients with potentially ischemic myocardium is as follows: 1. Careful work-up before proceeding if angina is present preoperatively. 2. Heavy premedication, attention to factors of preoperative anxiety, and avoidance of unnecessary painful procedures in the awake patient. Do not stop propranolol. 3. Monitoring of ST segments via V5 lead during anesthesia. Do not permit large fluctuations in systolic blood pressure or large increases in heart rate. 4. Maintenance of patient's temperature to obviate postoperative shivering. 5. Treatment of increased heart rate and ST segment changes with propranolol in 0.25-mg I.V. increments every 1 to 3 minutes until improvement noted (reasonable acute dose limit is 2 to 3 mg). 6. Treatment of ventricular arrhythmias with lidocaine bolus (50 to 100 mg) and infusion if more than one bolus is required (1 to 2 mg/70 kg/min), plus usual blood gases and electrolytes.