Ef 10 %

[canavarim]

guys
wat is ur opinion in inducing patiets with very low EF
ex. patients coming for ICD with 10 % EF , or coming for heart transplant ??
for ICD , do u prefer MAC , LMA , intubate ...??

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[Noyac]

guys
wat is ur opinion in inducing patiets with very low EF
ex. patients coming for ICD with 10 % EF , or coming for heart transplant ??
for ICD , do u prefer MAC , LMA , intubate ...??

It depends on the case.

But I always try not to drop their EF any.

 

[militarymd]

guys
wat is ur opinion in inducing patiets with very low EF
ex. patients coming for ICD with 10 % EF , or coming for heart transplant ??
for ICD , do u prefer MAC , LMA , intubate ...??

It is not the EF that concerns me in regards to induction....it is the severity of the Congestive Heart Failure symptions....ie inappropriately upregulated compensatory mechanisms.....sympathetic tone, renin level, adh level.....these hormones translate clinically into.....total body sodium, serum sodium concentration, total body interstital fluid volume....edema...etc.

In the well managed patient with low EF...ie little to no CHF symptoms, I induce them like any other patient....

In patients with many or severe symptoms of CHF...hyponatremia, pulmonary edema, peripheral edema, elevated bun/cr rations, etc.....I have phenylephrine readily available for the hypotension that is right around the corner after the induction.

In the patients going to the OR for heart transplant.....ie intractable CHF signs and symptom....I would just say...be ready for hypotension.

 

[Noyac]

So there you go. The difference b/w Mil and I. I'm a smartass and Mil just keeps putting out useful information.

 

[dr. mccoy]

Most ICDs placed at our institution are done under local with some sedation. I am not denying that your pt has a low EF, but usually 10% is almost incompatible with life, i.e. normal breathing without any activity probably takes 10% by itself. If you need to do GA, most inductions are usually predominantly narcotic do prevent cardiovascular swings. I hope you are doing some type of invasive monitoring if any signficant blood loss is anticipated.

 

[dr. mccoy]

Most ICDs placed at our institution are done under local with some sedation. I am not denying that your pt has a low EF, but usually 10% is almost incompatible with life, i.e. normal breathing without any activity probably takes 10% by itself. If you need to do GA, most inductions are usually predominantly narcotic to prevent cardiovascular swings. I hope you are doing some type of invasive monitoring if any signficant blood loss is anticipated.

 

[bullard]

I have seen at least 10 patients walk out the door of my hospital with EFs of 10% or less...more common than you might think...

 

[militarymd]

I have seen at least 10 patients walk out the door of my hospital with EFs of 10% or less...more common than you might think...

concur.

 

[catcolalex]

It is not the EF that concerns me in regards to induction....it is the severity of the Congestive Heart Failure symptions....ie inappropriately upregulated compensatory mechanisms.....sympathetic tone, renin level, adh level.....these hormones translate clinically into.....total body sodium, serum sodium concentration, total body interstital fluid volume....edema...etc.

In the well managed patient with low EF...ie little to no CHF symptoms, I induce them like any other patient....

In patients with many or severe symptoms of CHF...hyponatremia, pulmonary edema, peripheral edema, elevated bun/cr rations, etc.....I have phenylephrine readily available for the hypotension that is right around the corner after the induction.

In the patients going to the OR for heart transplant.....ie intractable CHF signs and symptom....I would just say...be ready for hypotension.

also be ready for hypotension after testing the defibrillator for ICD's in pts with low EF.