The role of fluid management in such patients with impaired renal function undertaken major bleeding surgeries like aneurysms.
role of beta-blocker or calcium=channel antagonist [or verapamil] has been established by dr K in managing dr T's patients.- almost 20 yrs back. it helps if relatively smaller was implanted in aortic position
b. fluid management helps in indicated patients
Generally, goal-directed hemodynamic management strategies include CI, SvO2, proper BP, and monitoring of urine output (0.5 ml/kg/hour or >). HOCM may benefit from liberalized volume (stiff/diastolic dysfunction) and pure vasoconstrictors paired with low dose inotropes (not avoided as classically teaching suggests). Tailor aforementioned to the patient's needs based on organ function and preexisting hemodynamics (BP, PA pressures, CVP, etc.).
Maintain high filling pressures and bradycardia perioperatively. This forms the key in management.
In case of pressors, phenylephrine is the choice.
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