Cardiac Tamponade

 

 

Considerations

 

  • Emergency with potential for cardiovascular collapse on induction

  • Pathophysiologic changes:

    • Impaired diastolic filling 

    • Fixed stroke volume 

    • Rate-dependent cardiac output 

  • Hemodynamic goals: 

    • Full, fast, maintain contractility, maintain SVR 

  • Etiologies/co-existing diseases:

    • Blood: post-cardiac surgery, post-MI, aortic dissection, trauma

    • Other: infectious, malignant, radiation, SLE, uremia, autoimmune, pericarditis

 

 

Goals

 

  • If hemodynamically significant, drain prior to general anesthesia & positive pressure ventilation (PPV)

  • Spontaneous respiration & avoidance of PPV, coughing, straining

  • Cardiovascular goals: fast, full and tight

    • Preload: full

    • Contractility: maintain, avoid myocardial depressants

    • Rate: maintain, possibly ↑

    • Rhythm: strict NSR

    • Systemic vascular resistance: maintain or