How
would you optimize this patient’s condition preoperatively?
Before surgery, it is essential to optimize the
physical condition in patients with mitral stenosis. The ventricular rate must
be slow and, when atrial fibrillation is present, it should be controlled with
drugs such as cardiac glycosides or β-adrenergic blockers. These drugs are continued
until the time of surgery. Hypokalemia from diuretics is cor-rected to prevent
digitalis toxicity and dysrhythmias. Although these patients are unusually
sensitive to narcotics and central nervous system depressants, an adequate
anesthetic premedication is important to prevent anxiety-induced tachycardia.
Supplemental oxygen is indicated in transit to the operating room.
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