Der Anaesthesist
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The probability of treating patients with valvular heart disease during non-cardiac surgery increases with the age of the patient. The prevalence of valvular heart disease is approximately 2.5% and increases further in the patient group aged over 75 years old. Patients with valvular heart disease undergoing non-cardiac surgery have an increased perioperative cardiovascular risk depending on the severity of the disease. ⋯ Depending on the underlying disease and the type of surgery planned a corresponding choice of anesthesia procedure and medication must be made. In the present review article the pathophysiology of the relevant valvular heart diseases and the implications for perioperative anesthesia management will be presented. An individually tailored extended perioperative monitoring allows hemodynamic alterations to be rapidly recognized and adequately treated.
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Surgical interventions in the sitting position are intended to optimize surgical conditions by reducing bleeding in the operation field and improving the surgical approach. There are, however, some potentially life-threatening risks associated with surgery in the sitting position. ⋯ In addition to standard monitoring procedures, transthoracic Doppler ultrasound and transesophageal echocardiography are valuable methods used to detect the presence of air in the vasculature. If an air embolism becomes apparent, further targeted measures are needed to prevent or aggressively treat the progression of potentially life-threatening consequences.