the pre-anesthetic concerns in the patient with coronary artery disease?
Pre-anesthetic anxiety will cause patients to
develop tachycardia. Patients with coronary artery disease should have adequate
anxiolysis, in the form of either pharma-cology or counseling, so that they do
not have a dramatic increase in oxygen consumption.
Patients with coronary artery disease also have
concomi-tant diseases such as hypertension and diabetes. Patients with severe
diabetes mellitus may be at risk for autonomic and peripheral neuropathy. That
is the reason why silent ischemia is so prevalent in the diabetic patient.
Diabetic patients may also have delayed gastric emptying if auto-nomic
neuropathy is present. Appropriate prophylaxis for a full stomach should be
Patients with hypertension have intravascular
hypo-volemia and may present with hypotension upon induction of anesthesia. It
is important to ascertain the volume status of the patient prior to induction
and to volume-load the patient to prevent hypotension. The response to
laryngoscopy may include tachycardia, which increases oxygen consump-tion.
Medication (narcotics, β-blockers, lidocaine) must be administered to
patients with coronary artery disease to ensure that they have a blunted
catecholamine release in response to intubation.