**8.3. Anaesthetic management**

A principle anaesthetic goal is to avoid psychological and physical stress that could trigger acute cardiomyopathy in susceptible patients. Thorough patient counselling, effective premedication and preoperative beta blocker therapy before transfer to operating room are highly effective.

Laryngoscopy, intubation, extubation, emergence, and inadequate postoperative pain control may cause a sympathetic response and increase catecholamine levels, so an optimal anaesthesia/analgesia is required in these phases. It is suggested that regional anaesthesia may be beneficial, but adequate studies to support this theory are not available.

It is unclear whether administration of inotropic drugs to treat systolic dysfunction is harmful. Inotrope of choice remains unclear, though Milrinone, aphosphodiesterase inhibitor, and a calcium sensitizer, levosimendan are suggested. Mechanical support of circulation with IABP or LVAD is an option to tide over periods of crisis. Beta blocker therapy may not be haemodynamically tolerated or could be potentially hazardous. Beta agonists should be avoided or used carefully, vasopressors may be used and supportive treatment for CHF should be instituted. LV dysfunction resolves within 2–4 weeks. Most cases recover spontaneously with a mortality risk of 0–8%.Recurrence occurs in 2–5% cases [10].
