Patients with untreated heart failure respond very poorly to general anaesthesia. Functional cardiac reserve is minimal even before the cardiosuppressant actions of general anaesthetic agents. Postoperative complications such as chest infections are also more likely. Hence, heart failure is a relative contraindication to general anaesthesia in all but emergency cases. For elective cases of proven benefit, the patient's condition needs to be optimal beforehand; this may require a pre-operative investigation and treatment admission.
If possible, emergency general anaesthesia in a patient with heart failure should be undertaken after a rapid administration of drug therapy e.g. intravenous diuretics. This may marginally improve an otherwise grave outlook.
Local or regional anaesthetic blocks are an alternative. Spinal anaesthesia is contraindicated because the reduction in sympathetic vasoconstriction reduces venous return and may precipitate cardiovascular collapse.
Patients with heart failure may have poor renal perfusion and hence the doses of some drugs should be reduced.
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