The main anesthetic goal for patients with acute cardiac tamponade is to maintain intrinsic sympathetic tone. These patients are extremely dependent on their intrinsic sympathetic activity, so maintenance of HR (likely compensatory tachycardia) and preload are of utmost importance in the setting of limited diastolic filling and stroke volume. An arterial catheter and large-bore intravenous access are essential. Inotropes such asepinephrine should be readily available and can be given in small doses to avoid bradycardia and hypotension. Positive pressure ventilation can precipitate hemodynamic collapse, but if tracheal intubation is necessary, rapid-sequence induction with succinylcholine or awake intubation can be performed. Ketamine and etomidate are considered appropriate agents for sedation and induction of anesthesia. Anesthesia should be induced and the trachea intubated only after prepping and draping the patient for a pericardial window have been completed in the event the patient suddenly becomes hemodynamically unstable and requires immediate drainage of the effusion (see Chapter 12: Cardiac Tamponade).

References

• Alerhand S, Carter JM. What echocardiographic findings suggest a pericardial effusion is causing tamponade? Am J Emerg Med. 2019;37:321-326.
• Appleton C, Gillam L, Koulogiannis K. Cardiac tamponade. Cardiol Clin. 2017;35:525-537.
• Argulian E, Messerli F. Misconceptions and facts about pericardial effusion and tamponade. Am J Med. 2013;126:858-861.