What is the perioperative medication management of congestive heart failure (CHF)?

Updated: Jan 09, 2018
  • Author: Nafisa K Kuwajerwala, MD; Chief Editor: William A Schwer, MD  more...
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Patients with congestive heart failure (CHF) need stabilization with diuretics, digoxin, ACE inhibitors, and nitroglycerides prior to surgery. Preoperative CHF is the strongest predictor of postoperative pulmonary edema.

Hemodynamic monitoring with a pulmonary artery catheter is recommended for patients with severe CHF requiring emergency surgery. This should extend at least 48 hours postoperatively to guide fluid management. Loss of cardiac pump function leading to CHF significantly increases perioperative risk.

Although postoperative CHF occurs in only approximately 1-6% of patients, the associated mortality rate is 15-20%. During surgery, volume changes, other intraoperative stressors, and the myocardial depressant actions of anesthetic agents can lead to a significant decrease in cardiac output.

Following surgery, most sequestered fluid is mobilized within the first 48 hours, placing an increased load on the heart. This is also a period of greatly increased metabolic and neurohumoral stress. Most postoperative CHF occurs within 1 hour following surgery, and, in 50% of these cases, inappropriate fluid administration is a major factor.

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