Aortic stenosis, role of 10

What is the role of 10?

These are 10 points you can remember about a particular subjects.Tthese 10 points if you speak about during your viva session your examiner will be thrilled.
If you expand each point during written exam you can cover the subject effeciently.
If you apply them clinically you patient is saved.

Aortic stenosis(AS)

1. It is nearly always congenital, rheumatic or degenerative 
2. AS---LV hypertrophy, reduced LV compliance, diastolic dysfunction.LV filling is quiet dependant on normal atrial contraction. 
3. Graded into:              Mild                    Moderate                                severe

    Aortic valve area            1.2-2cm             2 0.8-1                                        ˂ 0.8

Aortic-LV pressure gradient 16-34mmHg                    35-75                                           ˃ 75


4.   Anesthetic goals:

• maintain sinus rhythm 
• Maintain heart rate 60-90/m
• Maintain intravascular volume.

5. Premedication is useful in preventing unnecessary increase in heart rate and afterload.
6. Spinal and epidural are contraindicated in patients with severe AS.
7. Induction: primarily opioid based or combination of ketamine and benzodiazepine.
8. Maintenance is with opioid based technique.
9. Vecuronium, rocuronium can be used as muscle relaxant. Pancuronium is best avoided.
10. Phenylephrine is preferred as vasopressor over ephedrine because it lacks B agonist activity.