TAMPARIA, Darwin R.

40 year old male patient

- will undergo mitral valve replacement - DM, hypertension, renal insufficiency

- Diabetes mellitus - Hypertension - Renal insufficiency

-is a kind of metabolic disease that is brought about by either the insufficient production of insulin or the inability of the body to respond to the insulin formed within the system.

-High blood pressure; transitory or sustained elevation of systemic arterial blood pressure to a level likely to induce cardiovascular damage or other adverse consequences.

-malfunction of the kidneys resulting from any of a number of causes, including infection, trauma, toxins, hemodynamic abnormalities, and autoimmune disease, and often resulting in systemic symptoms, especially edema, hypertension, metabolic acidosis, and uremia.

-Echocardiogram -Color-flow Doppler examination -Cardiac catheterization -Chest x-ray -ECG (may show arrhythmias such as atrial fibrillation) -Chest MRI -CT scan of the chest

-surgical treatment of valvular disease. Mitral valve repair is used to treat regurgitation or stenosis of the mitral valve. It is treated by removing the diseased valve and implanting an artificial valve (valve replacement).

Non-pharmacologic: Diabetes mellitus - a number of lifestyle modification - (DPP) diet and exercise for 30 min/day five times/week -Maintain normal BMI and engage in regular physical activity

Pharmacologic: Diabetes mellitus - Type 1(or insulin dependent) wide range of formulations of Insulin - Type 2 Sulphonylurea group (e.g. chlorpropamide , glibenclamide , tolbutamide -biguanide (e.g metformin) -alpha-glucosidase inhibitors

Non-pharmacologic: Hypertension - Health promoting lifestyle modifications - weight loss - reduction of dietary naCl - food preference

Pharmacologic: Hypertension - Diuretics - Beta Blockers - Calcium channel blocker - ARB - Aldosterone Antagonist

General Anesthesia : Inhalational IV

Local Anesthesia :

Gaseous Anesthetics: -Nitrous oxide -Cyclopropane Volatile Anesthetics: A. Non-Halogenated -Ether -Chloroform

B. Halogenated -Halothane -Enflurane -Isoflurane -Methoxyflurane -Sevoflurane -Desflurane

-Isoflurane (2-chloro-2-(difluoromethoxy)-1,1,1trifluoro-ethane) is a halogenated ether used for inhalational anesthesia. -Its name comes from being a structural isomer of enflurane -produce adequate muscle relaxation -less nephrotoxic enflurane -less hepatotoxic halothane

Brand names: -Forane -Terrell Drug interactions: May increase the levels/effects of: -DOPamine -Epinephrine -Ephedrine -NorEpi

-absorbtion from alveoli into pulmonary capillary blood -distribution in the body -metabolism -elimination, principally via lungs

-Onset of action: 7-10 minutes (odor limits inhalation rate) -Duration: emergence time: depends on blood concentration when discontinued -Metabolism: minimally hepatic -Excretion: primarily as unmetabolized exhaled gases

-Shivering, nausea, vomiting and ileus have been observed in the postoperative period. Resp depression, hypotension, arrhythmias, malignant hyperthermia.