During surgery and anesthesia, patients are often in a state of stress, with sympathetic nerve excitation, increased catecholamine secretion, and peripheral vasoconstriction resulting in increased cardiac and vascular loads, inducing arrhythmia, angina pectoris, heart failure, hypertension or hypotension. Especially in the elderly, hidden arrhythmia, heart failure and myocardial ischemia can be aggravated, which makes anesthesia surgery difficult and easily leads to medical disputes. We discuss some of the commonly encountered similar problems, the main content: 1, hypertension and hypertension; 2, arrhythmia; 3, angina pectoris and myocardial ischemia; 4, cardiac function and heart failure, a hypertension and hypertension, hypertension, that is, preoperative hypertension, hypertension, that is, pre-existing hypertensive disease. Both are not absolute contraindications to surgery, as long as the operation or anesthesia before the blood pressure down to normal. Those with pre-existing hypertension must have their blood pressure controlled at a safe level before anesthesia, and this level is not absolute, depending on the size of the surgery, but also on the degree of damage to the heart, brain and kidneys. It is generally accepted that patients with hypertension ≥180/100 mmHg should continue to control their blood pressure before considering surgery. For those whose hypertension is easily induced by stress, it is easier to take preoperative sedative drugs or have hypertension before anesthesia, you can take some antihypertensive drugs under the tongue, such as 10mg of cardioplegia, 30mg of isobarbital, and 25mg of captopril, which can be repeated, and then anesthesia can be started after normalization of the blood pressure. This situation is often encountered before tooth extraction. Before anesthesia for surgical operation, there are ways to control the blood pressure, generally: 1. Use the above simple methods; 2. Intramuscular injection of drugs with moderate effect, such as intramuscular injection of 1ml of lipiodol, and there are a lot of similar medications; 3. Use of intravenous input of antihypertensive medications to control the blood pressure, the commonly used medications are sodium nitroprusside, 25-200mg/minute, titration rate to lower blood pressure to reach the ideal level, followed by a static drip of 7 minutes Tolamine, titration rate 100mg/minute, titration rate 100mg/minute, titration rate of 7 minutes Tolamine, titration rate 100mg/minute. Minute Tolamine, drip rate of 100-200mg / minute, Uradil (trade name Lijia Ding) 12.5-25mg added to saline drip …… some cases, static injection of tachycardia and other vasodilators are also effective. Second, arrhythmia (a) sinus tachycardia: very common before surgery and anesthesia, to find the cause, can not find the cause of the use of sedatives or a small amount of beta-blockers. (ii) Rapid atrial arrhythmias: these include atrial tachycardia, atrial tachycardia, atrial flutter, and atrial fibrillation. Atrial tachycardia and short bursts of atrial tachycardia can not be dealt with, atrial tachycardia, atrial flutter, atrial fibrillation will cause symptoms should be dealt with, the main use of digitalis drugs, such as cediran 0.4mg static can be repeated, part can be aborted, if ineffective, then you can choose: no organic heart disease, choose to use the cardioplegia 70mg static can be repeated, organic heart disease, choose to use the ethylaminolevulinone 2mg/kg, static can be repeated; the heart can not use the heart can not use the heart can not use the heart can not use the heart can not use the heart can not use the heart can not be repeated. Static injection can be repeated; Isobodin can also be used. (C) paroxysmal supraventricular tachycardia: this group includes: atrial tachycardia due to bypass refraction, and atrioventricular node double refraction tachycardia, tachycardia frequency in 160-220 times/minute often have a history of onset, generally can be the first with the eyeball pressure, carotid sinus compression method of physical stimulation, discontinuation of ineffective drug therapy, 1, static isobarbodine, 5mg ineffective can be repeated 1-2 times 2, static injection of cardioplegia, 70mg ineffective can be repeated 1-2 times 3, static injection of ethamidofuranone: 2-3mg/KG can be divided into two injections, can also be repeated. 4, static ATP5-15mg to be injected quickly 5, with hemodynamic disorders can be electrically restored, synchronous method of energy 100-200 Joule. (D) rapid ventricular arrhythmia: including ventricular tachycardia, short bursts of ventricular tachycardia, paroxysmal ventricular tachycardia, ventricular parkinsonism, ventricular fibrillation. Generally, ventricular tachycardia can be treated without treatment, short-paroxysmal ventricular tachycardia can also be observed, and ventricular tachycardia requires urgent treatment (except for non-paroxysmal ventricular tachycardia). 1.Litocaine:50mg静注，无效时可重覆，短时最好不要超过300mg。 2.Cardioplegia:70mg可以重覆。 3.Ethylamine iodofuranone:2mg/KG static injection can also be repeated. 4, slow heart rhythm injection can also be 100mg direct injection. 5.Electric cardioversion: ventricular tachycardia, 2020-300 Joule, ventricular flutter and ventricular fibrillation synchronization 300-400 Joule. (E) bundle branch block: single branch: one side of the right bundle branch and one side of the left bundle branch block is not a contraindication to surgery, may not affect the operation, but the complete left bundle branch block to pay attention to whether the heart is enlarged, the use of β-blockers with caution, complete double-bundle-branch block or triple-bundle-branch block should be installed to ensure the safety of the temporary pacemaker or permanent pacemaker and anesthesia surgery. (F) sinus bradycardia: the heart rate should be fast during surgery, if there is sinus bradycardia, to find the cause of the explanation, such as temporarily can not be found can be symptomatic treatment, you can first use atropine to improve the sinus rate. Methods:You can enter the pot atropine 0.5mg, muscle 0.5-1mg or atropine 1-2mg added to the drop in the liquid (generally 250-500ml) drops. When ineffective, isoproterenol can be used to drip at a rate of 0.5-1mg/min. (VII) sick sinus node syndrome: the elderly often have sinus node hypoplasia, but the diagnosis of sick sinus must have strict criteria for suspected patients anesthesia should be carried out before the determination of sinus function, the methods are: 1 atropine test 2 isopropyl renal test 3 esophageal regulation of the bo sinus node function determination. Confirmed diagnosis of diseased sinus patients surgical anesthesia should be installed temporary starter or permanent starter, then anesthesia and surgery. (H) atrioventricular block: 1-3 degrees, generally I ° AVB, does not affect the anesthesia. However, II° AVB should be noted for the possibility of progression to third degree and the slowness of its ventricular rate. The site of block can be categorized into two types: block of the AV node and block below the bundle branches. AV node block can be improved by atropine and corticosterone, while below bundle branch block, atropine is ineffective or worsens, and second to third-degree block requires temporary or permanent starting. Angina pectoris and myocardial ischemia Angina pectoris is divided into two types: stable and non-stable. In general, stable angina can be treated with surgery and anesthesia as long as it is not scheduled during an attack. Before anesthesia, adequate treatment should be carried out, and preventive drugs can be given, such as 1 nitroglycerin tablet before anesthesia, or low concentration of intravenous nitroglycerin solution, but myocardial infarction in the acute stage or unstable angina pectoris should be postponed surgery. If angina attack occurs during surgery, the symptoms should be controlled actively and rapidly, either by taking nitroglycerin under the mouth or tongue or by intravenous nitroglycerin drip, and then continue the surgery after the disease is controlled. Myocardial ischemia that occurs before and during surgery is a commonly encountered problem, and intraoperative monitoring provides a convenient way to determine and treat it. It is very important to determine whether myocardial ischemia and the degree of ischemia before or during surgery. There are many reasons for ST-T changes, and it is important to determine the ST-T changes, which are caused by hypertension, myocardial hypertrophy, medications for end-branchial conduction block, electrolyte disorders, vegetative nerve disorders, and endocrine factors, and the ST-T changes are all of the horizontal, pendulous, and bowed-back ST depression, and are seldom oblique upward, and most of them have localization, correspondence, and dynamics. With the characteristics of localization, correspondence and dynamics, this is the key point of identification, to determine myocardial ischemia, but also to determine the degree of myocardial ischemia, ST ↓ ≥ 2mm T inversion > 5mm is considered to be severe ischemia. Surgery that is known to be deferred preoperatively is improved intraoperatively before surgery. Sometimes this change is associated with anemia, and insufficient blood volume is also related to the common method is adequate correction of anemia and blood volume supplementation with intravenous nitroglycerin at a drip rate of 5-40mg/min. Large-scale heart surgery, open-heart surgery and other major surgery before the operation to determine the heart coronary artery and reserve capacity is also very important, especially the elderly with a history of heart disease should be coronary angiography, there are obvious lesions should be in the coronary artery bypass grafting before the operation. Third, cardiac function and heart failure cardiac insufficiency is not an absolute contraindication to surgery, mainly depends on the risk of surgery and the degree of cardiac insufficiency, with a history of heart disease or the elderly anesthesia before surgery should be effective detection of cardiac function, the general method is ultrasound noninvasive cardiac function test, that is, the determination of SV (per boe output), CO (per minute of boe output) CI (cardiac index), but the influence of these values of the factors, mainly the determination of EF value (EF value), the EF value (per minute of boe output) CI (cardiac index). EF value (EF=EDV-ESV/EDV) EF<50% can be judged as cardiac insufficiency, in the elderly with a history of heart disease, and in the operation found in heart failure can be dealt with in accordance with the following principles: 1, even if the EF is normal in the elderly, due to surgical anesthesia is in a state of stress, can be used prophylactically cardiac agents, such as digoxin 0.25mg once a day for three days, or before the operation static injection of cediran, if necessary during the operation can be used as a preventive agent. Cediran, which can be repeated if necessary during surgery. 2, heart enlargement or history of heart disease can also use prophylactic digitalis therapy. 3, occult heart failure EF <50% but asymptomatic preoperative treatment with cardiotonic agents and necessary diuretics must be used. 4, intraoperative found symptoms of cardiac insufficiency, immediately given cardiotonic agents static sildenafil or poisonous trichothecenes K, at the same time to reduce the cardiac load using vasodilators and diuretics, such as static tachycardia 20mg static sodium nitroprusside titration rate of 25-200mg / min, phentolamine 100-200mg / min, in order to control heart failure.