Coronary disease and anaesthesia

The anaesthetic care of patients with coronary artery disease can probably be improved. The goal is to maintain a favourable myocardial oxygen supply/demand ratio. This may necessitate the use of beta-blockade and vasodilators, or alternatively perhaps halothane, in order to reduce arterial pressure and heart rate, and thereby reduce myocardial work. Normoventilation and adequate analgesia help to prevent increases in peripheral resistance. Careful ECG monitoring may reveal ischaemia or left ventricular strain, which should be regarded as an indication to reduce myocardial work.