Surgery

Biography

Biography: Kanishka Indraratna

Abstract

Peri operative cardiac failure carries a high morbidity and mortality and its occurrence can spell catastrophe for allrnconcerned. Peri operative cardiac failure can occur due to decompensation of existing cardiac dysfunction, acute ischaemicevent, or overloading of fl uid or an increase in the aft erload. During anaesthesia any of these can occur particularly if the heart function is already compromised. It may occur due to myocardial depression, an imbalance in the coronary oxygenrnsupply, inappropriate transfusion of fl uid or vasoconstriction. Th e traditional methods used for evaluating optimum cardiacfunction intra and peri operatively were measurements such as the cvp and pcwp whose value has been questioned. To preventrnand manage peri operative heart failure , there should be methods of assessing cardiac function and to monitor whetherrntherapeutic manipulations have the desired eff etc. It is important to monitor the volume status, whether giving fl uid challengesrnis safe, whether the contractility of the myocardium is satisfactory, whether it is deteriorating, whether it needs inotropes. Isthe heart dilated, and does it need to be overloaded? Would a vasoconstrictor or vasodilator help. Th is presentation , shows how transoesophageal echocardiography can be used to obtain this required information and thereby help in preventing andmanaging peri operative cardiac failure.