Anesthetic Management of the Cardiac Patient *

Management of the cardiac patient includes pre-operative, anesthetic, operative, and postoperative procedures which interfere minimally with physiological function. All phases of surgical care are affected by the drugs and anesthetics used, but of paramount importance to the anethesiologist is the actual anesthetic procedure. A technic should be selected that will provide optimal working conditions, yet will not jeopardize the patient's life and will enable him to recover postoperatively. In order to achieve these all-inclusive aims there are three major requirements: 1. Evaluation of physical status, cardiac condition, and cardiac capacity. 2. Knowledge of the effect of various anesthetic agents and technics on the heart and circulation. 3. An anesthesiologist. For evaluation of the physical status and determination of the degree of functional cardiac disturbance the internist, but more particularly the cardiologist, must be consulted. With him rests the final cardiac diagnosis, determination of the extent of cardiac damage, and the estimation of the cardiac reserve. This last factor must be made known to the anesthesiologist. It is the key to successful anesthesia and surgery, and generally any added risk is proportional to the degree of decrease in cardiac reserve.6 Oftentimes valuable information may be obtained by simple procedures such as questioning the patient as to what work he can perform without developing symptoms; the commonly used "step test" is also useful while the breath-holding test, which is simple and quick, has been recommended by Rovenstine.30 In this test the patient is asked to hold his breath and the duration of breathholding will give a rough index of cardiac reserve. The rapid occurrence of dyspnea under any circumstance of mild stress indicates rather serious impairment. This symptom must always be kept in mind because although it is a subjective symptom manifested by the conscious patient,