Emphasizes the need to manage hemodynamics during cardiovascular surgery by integrating contractility, afterload, and preload, and highlights the lack of established analgesic methods that ensure hemodynamic stability.
Integrated hemodynamic management remains essential in cardiovascular surgery; leaves open validated analgesics preserving stability.
左室の後負荷が上昇し続けるとafterload mismatchが発生して，心収縮力が低下し1回心拍出量（SV）が減少する．この治療にあたっては左室と動脈系を整合（ventriculo-arterial coupling）させねばならず，心収縮力（Ees）と後負荷（Ea）の両面から治療方針を考える．さらに，血行動態は心収縮力，後負荷，前負荷が連動して変動するので，麻酔中は3者を相互に関連づけて病態把握と管理をせねばならない．手術終了後，術後管理への移行期の鎮痛を確実に行い，不利な循環変動を回避せねばならない．しかし，現時点では鎮痛薬と血行動態安定化を両立させるような鎮痛法は確立されておらず，今後の検討が必要である．
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Toshiyuki Oda (2010) studied this question.
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