Valvular heart disease: Anesthetic considerations in non-cardiac surgery

In all cases of valvular heart disease one should avoid heavy premedications. This will ensure that the balance between preload and afterload is maintained and will avoid respiratory depression which may aggravate pulmonary hypertension. Agents which depress the myocardium should be avoided (an opiate technique is preferable to a technique based on volatile agents). Agents which cause a tachycardia should be avoided. Controlled ventilation is safer than spontaneous ventilation. Appropriate monitoring is essential in every case.