In the anesthesia management of 40 elderly patients with maxillofacial tumors and myocardial ischemia, the heart rate is bidirectionally regulated within a safe range, effectively avoiding an increase in heart rate for this elderly group. The induction of general anesthesia with etomidate has minimal impact on cardiovascular function. Intravenous injection at 0.3 mg/kg slightly decreases arterial pressure and peripheral resistance while increasing cardiac output and cardiac index, slightly slowing down the heart rate. There is also a slight dilation of the coronary artery, reducing drag, increasing blood flow, and decreasing myocardial oxygen consumption without obvious changes in myocardial contraction force, favoring patients with impaired myocardial oxygen consumption and blood supply. Maintaining cardiovascular stability is one of the great advantages relied upon by the author using etomidate as an inducing drug.
The oral and maxillofacial region is rich in blood supply, and prolonged surgery and anesthesia can exacerbate bleeding. In elderly patients with combined myocardial ischemia, appropriate anesthesia depth, smooth anesthesia maintenance, prevention of choking and blood pressure fluctuations, and maintaining hemodynamic stability are key during anesthesia. Based on electrocardiogram, blood pressure, heart rate, heart rhythm, and oxygen saturation monitoring results under anesthesia, nitroglycerin, metoprolol, and lidocaine are used to control blood pressure, heart rate, and rhythm, achieving good perioperative cardiovascular and hemodynamic stabilization effects.
Nitroglycerin has a direct relaxant effect on vascular smooth muscle, causing simultaneous dilation of small arteries and veins, reducing systolic and diastolic blood pressure, markedly dilating the coronary artery, lowering left ventricular diastolic pressure and wall tension, favoring coronary artery blood flow from epicardial flow to endocardium, thereby improving myocardial ischemia, especially applicable in coronary heart disease patients. A major drawback of nitroglycerin is the simultaneous buck appearance, which increases heart rate and myocardial oxygen consumption, requiring attention and prevention.
Metoprolol, a short-acting beta receptor blocker, may slow the heart rate, lower systolic blood pressure, reduce myocardial oxygen consumption, and increase coronary blood flow but excessive dosage can inhibit myocardial contractility. It is suggested that there are three independent beneficial effects on myocardial ischemia following cardiac benefits: improving the balance between myocardial oxygen supply and demand, antiarrhythmic effects, and reducing the hemodynamic triggering effect on plaque rupture.
Based on the experience of perianesthesia management in 40 elderly cases with myocardial ischemia and maxillofacial tumor operations, the author suggests paying attention to the following aspects: strengthening preoperative preparation, appropriately correcting comorbidities, improving myocardial ischemia, controlling blood pressure, and correcting arrhythmia. Anesthesia medication induction dosage should differ from person to person, avoiding excessive tachycardia injections. Timely correction of dehydration due to forbidden drinking, accurate estimation of blood loss, maintaining adequate blood volume, closer monitoring of respiration throughout the operation, ensuring adequate ventilation and sufficient oxygen supply, maintaining steady circulatory function, and actively implementing postoperative analgesia.
In summary, using etomidate, propofol, remifentanil intravenous anesthesia, maintaining a certain depth, ensuring sufficient oxygen supply, strengthening intraoperative monitoring, and appropriately discretionary use of nitroglycerin and metoprolol to maintain cardiovascular and hemodynamic stability, is key in managing anesthesia for elderly maxillofacial tumor patients combined with myocardial ischemia.