Longnecker's Anesthesiology > Part 4. Managing Anesthesia Care > Section C. Anesthesia Drugs and Drug Delivery Systems > Chapter 43. Cardiovascular Drugs Alina Nicoara, MD, Mark Abel, MD, David Bronheim, MD, and Daniel Thys, MD

Key Points

"1. Patients with preoperative blood pressure elevation have exaggerated perioperative blood pressure fluctuations, which may be associated with electrocardiogram (ECG) evidence of myocardial ischemia. The American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for Perioperative Cardiovascular Evaluation for Noncardiac Surgery recommend that antihypertensive medication be continued during the perioperative period. Particular care should be taken to avoid withdrawal of -blockers and clonidine because of the potential for catastrophic withdrawal syndromes.

2. Recommendations for patients taking diuretics, call for withholding diuretics on the day of surgery unless evidence suggests volume overload or signs and symptoms of overt congestive heart failure (CHF). In stable patients with chronic mild-to-moderate hypokalemia without signs or symptoms of hypokalemia (e.g., muscle weakness, ileus, and nephropathy) and in the absence of dysrhythmias or digitalis use, anesthesia and surgery can proceed.

3. ₂-Agonists have many desirable effects such as minimum alveolar concentration (MAC) reduction, analgesia, anxiolysis, sedation, and sympatholysis. Recent studies evaluating the perioperative effect of ₂-agonists during noncardiac..."