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1. Cardiothoracic Procedures Flashcards

1
Q

3 cardiac surgery approaches

A

“open” heart surgery
davinci robotic
endovascular

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2
Q

open heart surgery definition

A

any time the chest is opened (sternotomy or thoracotomy)

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3
Q

davinci robotic cardiac surgery definition

A

more laparoscopic rather than open bc small incisions and smaller insufflation is utilized

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4
Q

endovascular cardiac surgery definition

A

possible for valve repair and types of aortic repair

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5
Q

is sternotomy invasive or minimally invasive?

A

invasive

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6
Q

is thoracotomy invasive or minimally invasive?

A

minimally invasive

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7
Q

is davinci invasive or minimally invasive?

A

minimally invasive

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8
Q

is endovascular repair invasive or minimally invasive?

A

minimally invasive

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9
Q

invasive

A

open sternotomy

provides best exposure but most complications

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10
Q

minimally invasive cardiac surgery (MICS) types (3)

A

thoracotomy, davinci, endovascular

less common but gaining popularity

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11
Q

“minimally invasive”

A

operation without sternotomy

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12
Q

3 things specific to minimally invasive cardiac surgery

A

called MICS
double lumen tube must be used
can be off pump or on pump with femoral vessels

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13
Q

two types of aorta surgery

A 
open repair with cross clamps
endovascular repair (minimally invasive)
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14
Q

6 surgical options for CABG

A 
full bypass with arrested or beating heart
partial bypass with beating heart
off pump

sternotomy
thoracotomy
davinci
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15
Q

MICS CABG

A

small thoracotomy incision
typically 1-2 anterior vessels
off pump or on pump with femoral vessels

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16
Q

davinci CABG

A 
robot harvest the LIMA
thoracotomy is used to sew on graft
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17
Q

hybrid coronary revascularization

A

1) anterior vessels are bypassed using MICS/thoracotomy
2) posterior vessels are stented by interventional cardiologist

allows cardiac option for all vessels without sternotomy

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18
Q

purpose of hybrid coronary revascularization

A

avoid sternotomy

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19
Q

what does the hybrid room require?

A

built in fluoroscopy

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20
Q

what procedures will happen in a hybrid room?

A
  1. hybrid coronary revascularization
  2. TAVR/TAVI

transcatheter aortic valve replacement (TAVR)((or TAVI))

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21
Q

what two types of surgeons will be in the hybrid room?

A

cardiac surgeon
interventional cardiologist

interventional cardiologist

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22
Q

what is a good premedication for CABG

A

versed– prevent anxiety and tachycardia

CABG pts need more than valve replacement

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23
Q

surgical options for valve repair/replacement 6

A
  1. full bypass with arrested or beating heart
  2. right heart bypass for tricuspid or pulm valve
  3. endovascular or transapical valve replacement (off pump)
  4. sternotomy
  5. thoracotomy
  6. davinci (femoral vessels)
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24
Q

how do we normally fix stenotic valves?

A

replaced

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25
Q

how do we normally fix regurgitant valves?

A

repaired or replaced

repair is more likely for regurg than for stenotic

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26
Q

can you use versed for valve repair/replacement?

A

NO,

these pts need to maintain their preload and afterload

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27
Q

are MICS valve repair/replacement more commonly performed on or off pump?

A

on pump via femoral arteries

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28
Q

endovascular valve repair, what types of patients get this surgery?

A

ONLY pts who dont qualify for open heart surgery

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29
Q

what % of pts with aortic stenosis are considered too high risk for surgery?

A

30-40%

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30
Q

endovascular aortic valve replacement two names

A

TAVR transcatheter aortic valve replacement
TAVI transcatheter aortic valve implantation

TAVI transcatheter aortic valve implantation

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31
Q

endovascular aortic valve replacement catheter/stent pathways 2

A 
femoral artery (more common)
or
axillary artery
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32
Q

pathway for endovascular mitral valve repair

A

femoral vein -> intra-atrial septum -> mitral valve

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33
Q

pathway for tricuspid and pulmonic valve repair

A

starts in femoral vein and goes up to valve by passing through right heart

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34
Q

transapical open valve replacement

A

valve replacement that is performed off pump with an open approach

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35
Q

5 risks associated with TAVR

A 
1 stroke & TIA
2 perivalvular leak
3 acute kidney injury
4 LBBB
5 postoperative bleeding and atrial fibrillation
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36
Q

overall paravalvular leak/aortic regurge post valve insertion

A

50-85%

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37
Q

which is a higher risk of stroke? surgical valve replacement or TAVR

A

TAVR

30 day frequency is 2-6%

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38
Q

30 day stroke risk post-TAVR

A

2-6%

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39
Q

what is the % of aortic regurg as high as immediately post TAVR?

A

85%

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40
Q

1 year aortic regurge post-TAVR

A

75%

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41
Q

what fraction of patients have more than mild mitral regurg?

A

1/3

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42
Q

how can you limit vascular complications?

A

use the transapical thoracotomy approach

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43
Q

why is there a risk of acute kidney injury during TAVR?

A

large contrast load used in placing the valve with fluoroscopy

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44
Q

how does cardiac conduction abnormalities happen during TAVR?

A

final prosthesis position impinges conduction system

high incidence of LBBB

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45
Q

what is the incidence of complete heart block in pts that already have RBBB for TAVR surgery?

A

19-22%

could require pacemaker implantation

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46
Q

most frequent adverse outcome with TAVR

A

bleeding from femoral blood vessels

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47
Q

what TAVR risk is less likely to happen than with open surgical approaches?

A

post op bleeding and a fib

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48
Q

10 steps of anesthetic management for endovascular TAVR

A

1 renal protection
2 stroke prevention
3 lower dose of heparin
4 placement of transvenous pacing leads
5 attaching of external defibrillator pads
6 utilization of TEE
7 amicar administration UNNECESSARY
8 prep to keep heart still during valve deployment
9 hemodynamic goals for typical pt with aortic stenosis
10 continuous postop EKG monitoring for 48 hrs

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49
Q

what 2 things can provide renal protection during TAVR?

A

1) adequate volumes
2) N-acetylcysteine

N-acetylcysteine prior to surgery

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50
Q

stroke prevention steps TAVR

A

dual antiplatelet therapy is started before surgery and continued for 6 months
300-325mg loading dose of aspirin
300mg clopidogrel

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51
Q

what is the goal ACT after heparin dose for TAVR

A

> 250

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52
Q

what are the two reasons that we place pacing leads during a TAVR

A

establish rapid ventricular pacing during valve placement (180-220bpm)

pace heart in case of complete heart block at end

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53
Q

why do we attach external defibrillator pads on TAVR pts?

A

life threatening arrhythmias can occur in 4% of pts

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54
Q

life threatening arrythmias can occur in ______ % of TAVR pts?

A

4%

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55
Q

why do we use TEE during TAVR

A

provides information about results, position and complications of TAVR

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56
Q

what are the two options to keep the heart still during TAVR?

A

RVP rapid ventricular pacing

12 mg adenosine to stop the heart

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57
Q

RVP rate

A

180-220 bpm

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58
Q

what will happen to BP when you keep the heart still during TAVR? treatment?

A

hypotension

-ask surgeon whether or not to treat (usually not bc its short)

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59
Q

how long does valve deployment take?

A

12 seconds

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60
Q

what are the 4 hemodynamic goals for a pt with aortic stenosis

A

preload augmentation
low heart rates (50-70bpm)
mx afterload
maintenance of sinus rhythm

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61
Q

why do you monitor EKG for 48 hr post TAVR?

A

monitors for onset of new rhythm disturbance

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62
Q

in what patients are the pacing wires left in place post op?

A

av block pts to prevent cardiac arrest

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63
Q

what are the two types of surgery to repair thoracic aorta

A
  1. cross clamps with graft (open abdominal aortic aneurysm)
  2. endovascular aortic stent

endovascular stent

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64
Q

what is the more common thoracic aorta surgery?

A

endovascular stent

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65
Q

do endovascular stent patients receive heparin?

A

Yes - lower dosing

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66
Q

do endovascular stent patients receive amicar?

A

no

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67
Q

aortic root replacement anesthetic plan

A

clamp placed on ascending aorta and treated as traditional bypass with arrested heart

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68
Q

where is the clamp for aortic root replacement?

A

ascending aorta

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69
Q

surgical techniques for open ascending aorta repair (you can place cross clamp on ascending aorta)

A

traditional bypass

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70
Q

surgical techniques for open ascending aorta repair (you can NOT place cross clamp on ascending aorta)

A

1) deep hypothermic circulatory arrest (with or without retro or antegrade cerebral perfusion)
2) normothermic antegrade cerebral perfusion

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71
Q

what is the problem with descending aorta repair?

A
  • not possible to perfuse head and lower body with one arterial cannula
  • clamps increase chance of paralysis due to decr spinal cord perfusion
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72
Q

what are the bypass options for descending aorta repair?

A 
left heart partial bypass
circ arrest (decrease risk of organ dysfunc. and paralysis)
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73
Q

LH partial bypass overview

A

1/2 blood out of LA perfuses distal to clamp
1/2 blood in heart perfuses proximal to clamp

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74
Q

LHPB: lower extremity perfusion

A

LA –> bypass –> arterial cannula –> lower extremities
(distal to clamp)

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75
Q

LHPB: head perfusion

A

LV –> head
(proximal to clamp)

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76
Q

how many a lines in LHPB?

A

2:
- right radial artery
- femoral artery

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77
Q

what do we compare during LHPB to assess filling of ventricles?

A

CVP vs PCWP

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78
Q

which a-line site is proximal to clamp?

A

right radial artery

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79
Q

why do you use the right radial artery?

A

because clamping proximal to the left subclavian might be necessary which will mean the left radial will not be proximal to clamp

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80
Q

which a-line site it distal to clamp?

A

femoral artery
foot artery

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81
Q

PLHB:
high proximal
low distal

How should you fix?

A

increased flow through circuit

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82
Q

LHPB:
proximal low
distal low

How to treat?

A

consider vasoconstrictor or fluids

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83
Q

LHPB:
proximal high
distal high

how to treat?

A

consider vasodilator

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84
Q

CVP&raquo_space; wedge pressure

A

decrease flow through circuit

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85
Q

wedge&raquo_space; CVP

A

increase flow through circuit

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86
Q

anesthetic management for open descending aorta repair (4)

A

place aline in right arm
insert a double lumen tube
prepare cardiac drugs
consider techniques for spinal protection

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87
Q

why do we need to place the aline in the right arm for open descending aorta repair?

A

bc the clamp may need to be placed proximal to the left subclavian

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88
Q

why do we need a double lumen tube for open descending aorta repair?

A

bc a thoracotomy approach will most likely be used

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89
Q

spinal cord protection techniques for open descending aorta repair (4)

A
  1. SSEP/MEP monitoring
  2. Lumbar drain
  3. Steroids (decrease swelling)
  4. Consider Mannitol
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90
Q

what does a lumbar drain do?

A

decreases ICP =
increases spinal cord perfusion pressure

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91
Q

spinal cord perfusion pressure equation

A

= MAP- CSF pressure

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92
Q

CPP =

A

CPP = MAP - ICP

93
Q

why use mannitol to protect the spine?

A

increases spinal cord perfusion (decreasing CSF production)
improves renal perfusion

improves renal perfusion

94
Q

aortic wrapping procedure description

A

open chest procedure to treat aortic aneurysm
less common
reserved for those concomitant aortic valve replacement and too high risk

95
Q

what is the aortic wrap supposed to do?

A

prevent aneurysm rupture

96
Q

what are the two ways that heart transplants can be classified as

A

orthotopic heart transplant
heterotropic heart transplant

heterotopic heart transplant (piggyback)

97
Q

orthotopic heart transplant description and techiques used

A

replaced recipient heart with donor heart

biatrial, bicaval, or total heart transplant

98
Q

heterotopic heart transplant (piggyback)

A

donor heart is placed in right chest next to recipient heart and anastomosed so blood can flow through either or both

99
Q

biatrial heart transplant

A

only ventricles are removed
leaving both atria intact

donor heart attach at midatrial level

100
Q

biatrial heart transplant attachment level

A

mid-atrial level

101
Q

biatrial heart transplant anastomosis required

A

4

102
Q

bicaval heart transplant

A

entire right atrium is removed but the left atrium remains intact
- right side of donor side attaches to right side of pts heart

103
Q

bicaval heart transplant anastomosis required

A

5

104
Q

total heart transplant

A

removes the entire heart including left atrium

105
Q

total heart transplant anastomosis required

A

6

106
Q

what are the advantages of having less anastomosis (comparing heart transplant techniques)

A

shorter operation times

less anastomotic complications

107
Q

What heart transplant method gives the best post op function? downfall?

A

total heart transplant

downfall: longer operation times

108
Q

pts with heart failure are more likely to develop

A

PHTN
RV hypertrophy

109
Q

pts with heart failure and PHTN have

A

weak left ventricle
strong right ventricle

110
Q

severe PHTN pt that receives heart transplant is more likely to ahve what problem?

A

right heart failure due to high pulmonary vascular resistance but with a new normal right ventricle

111
Q

transplant options for pt with PTHN

A

heterotropic heart transplant

112
Q

after heterotropic transplant in pt with CHF and PHTN: “old” heart

A

strong RV
effectively pumps majority of blood to lungs

113
Q

after heterotropic transplant in pt with CHF and PHTN: “new” heart

A

strong LV
effectively pumps majority of blood to body

114
Q

explain normal heart vagus nerve and SA node mechanism

A

presynaptic vagus nerve releases Ach binds to MR on SA node and slows HR (balances to prevent tachy)

115
Q

explain normal heart when atropine/robinul are given

A

atropine/robinul block the MR on the SA node and the Ach does not bind
HR increases

116
Q

pt with heart transplant is denervated, what does this mean

A

not connected to sym or parasym nerves
So the SA node does not have the constant vagus nerve input
pt expected to have higher resting HR

117
Q

do atropine/robinul increase the HR in pts with heart transplants?

A

no

118
Q

effect of atropine/robinul on pt with heart transplant

A

will still bind MR on heart but there is no Ach to block
no effect on HR

119
Q

can neostigmine cause bradycardia in patients with heart transplant?

A

yes - floods body with Ach which will Lower HR

bc neostigmine floods the BODY with Ach and that can reach the SA node

120
Q

when can atropine/robinul increase the HR of a pt that had a heart transplant?

A

when the bradycardia was caused by neostigmine

121
Q

do you still give atropine/robinul with neostigmine in pts with heart transplants?

A

yes, you still need to prevent the bradycardia due to neostigmine
Atropine/robinul will block flood of Ach

122
Q

what is the heart transplant option for patients with pulmonary HTN?

A

heterotopic heart transplant

2 hearts in pt

123
Q

what will happen after time with the heterotopic heart transplant?

A

pulm HTN will resolve and RV will return to normal size and more evenly share load with donor heart

124
Q

heart transplant implications (7)

A

1- resting HR >90bpm
2- atropine/robinul administered alone have no effect
3- neostigmine causes bradycardia (antimuscarinics used to counteract)
4- bradycardia must be treated with pacing or beta 1 agonist
5- pt cannot experience angina
6- baroreceptor reflex doesnt work (reflex brady doesnt happen)
7- 2 SA nodes in biatrial technique will cause 2 P waves
(donor SA node is responsible)

125
Q

what are the beta 1 agonists used to treat bradycardia when denervation

A

isoproterenol
dobutamine
epi
NE

126
Q

what is the clinical significance of 2 SA nodes

A

original SA node signal cannot cross suture line
- donor SA node effects the HR of pt

thus donor SA node is the only one that effects HR of pt

127
Q

What should PAP be kept at during heart transplant?

A

low PAP to prevent RH failure

128
Q

what electrolyte imbalance is common post-transplant?

A

hyperkalemia

129
Q

how often is RV failure an issue with heart transplants?

A

accounts for 20% of early deaths

130
Q

what are strategies to reduce pulmonary artery pressure during heart transplant?

A

hyperventilation
higher FiO2
pulm artery vasodilators
avoidance of acidosis

131
Q

what is methylprednisolone

A

steroid that is used to prevent rejection of transplant

dosed when crossclamp released

132
Q

when is methylprednisone dosed?

A

when cross clamp is released

133
Q

what are ways to lower plasma K?

A

hyperventilation

134
Q

what is the bypass circuit for heart transplants

A

venous cannulas in SVC and IVC, arterial cannula in aorta

135
Q

transmyocardial laser revascularization (TMLR) or TMR

A

laser creates series of holes in myocardium

relieve angina for pt not eligible for bypass/anginoplasty or have no more grafts

136
Q

TMR purpose

A

relieve angina in pts who are not eligible for bypass or angioplasty

137
Q

what are the two theories for TMR efficacy?

A

1- stimulates angiogenesis (new channels for blood flow)
2- destroys nerve endings

138
Q

what can the laser trigger in TMR?

A

arrythmias
- treat with antiarrythmic prophylaxis
decr CO
- treat with vasopressors/inotropes

139
Q

how to treat decr CO in TMR?

A

vasoperessors
inotropes

140
Q

what tube for TMR?

A

double lumen tube
(left anterior thoracotomy w/left lung isolation)

141
Q

pericardial effusion

A

fluid around the heart

“fluid accumulation in the pericardial cavity”

142
Q

cardiac tamponade

A

when pericardial effusion is big enough to effect cardiac function (decrease EF)

143
Q

what are cardiac tamponade patients at risk for?

A

hypotension
cardiac arrest
especially during induction

144
Q

hemodynamic effects of cardiac tamponade 3

A
  1. decreased CO (bc of decreased SV)
  2. beck’s triad
  3. pulsus paradoxus

2 becks triad

145
Q

what is becks triad

A

hypotension
jugular venous distention
muffled heart tones

146
Q

what are the two treatment options for cardiac tamponade

A 
pericardiocentesis (local or sedation)
pericardial window (general anesthesia)
147
Q

pericardiocentesis anesthetic plan

A

MAC

148
Q

pericardial window anesthetic plan

A

GA

149
Q

what type of approach is used when the tamponade is an emergency?

A

subxiphoid approach (can be performed under local and sedation if required)

150
Q

what type of tube is used in the subxiphoid approach?

A

single lumen ETT

151
Q

what type of tube is used in the thoracotomy approach?

A

double lumen ETT

152
Q

induction of anesthesia for pericardial window

A

head elevated 45 degrees
propofol avoided
avoid bradycardia
surgeon ready before induction

153
Q

induction agent for pericardial window

A

ketamine
etomidate

154
Q

in a patient with cardiac tamponade what does cardiac output depend on? SV or HR?

A

HR because the heart cannot increase SV

bradycardia must be avoided

155
Q

Do you want positive pressure ventilation or spontaneous ventilation during a pericardial window/tamponade?

A

spontaneous
PPV decreases venous return and CO
awake fiberoptic good option

156
Q

mediastinoscopy

A

visualization of contents of space between lungs (mediastinum) usually for biopsy

157
Q

what is the problem with the scope for mediastinoscopy?

A

ability to compress innominate (brachiocephalic) artery

surgeon not aware need to communicate this

158
Q

what does the innominate artery supply blood to?

A

right arm (subclavian) and right common carotid

159
Q

what can happen with innominate compression?

A

decreased cerebral blood flow

160
Q

what patients are at risk for cerebral ischemia with innominate artery compression?

A

pts who have left carotid stenosis

161
Q

where should you place a-line in mediastinoscopy?

A

right radial artery will indicate innominate artery compression

162
Q

aiway management for mediastinoscopy

A

single lumen ETT
no lungs need to be down
Spontaneous ventilation best

163
Q

blood pressure monitors for mediastinoscopy

A

aline in right radial artery (know immediately if innominate is compressed)
NIBP left arm for when aline is jacked up

164
Q

what is mandatory for mediastinoscopy?

A

monitor pulse in right arm

165
Q

what is the less common blood pressure monitoring for mediastinoscopy?

A

aline in left arm (monitors continuously)

SpO2 on right (use waveform to watch for compression)

166
Q

what is the primary concern with mediastinal mass?

A

compression of vital structures

167
Q

what vital structures can be compressed by a mediastinal mass?

A

heart
central blood vessels
trachea
bronchi

168
Q

what are the pts with mediastinal mass at risk for during induction

A

airway collapse

cardiovascular collapse

169
Q

what are the signs/symptoms of mediastinal mass?

A

superior vena cava syndrome
pembertons sign
tracheobronchial compression

170
Q

superior vena cava syndrome

A

obstruction to venous return through SVC

171
Q

what is the most common cause of SVC syndrome?

A

malignancy

172
Q

what can obstructed venous return lead to?

A

airway edema
decreased CO
increased ICP

(superior vena cava syndrome)

173
Q

what happens to a persons face during SVC syndrome

A

swelling in face in morning
(can be positional)

swelling resolved after being upright all day

174
Q

pembertons sign

A

facial congestion
cyanosis
respiratory distress when raising both arms
(shifts mass to cause obstruction)

175
Q

what does pembertons sign illustrate about positioning

A

positioning moves the tumor which can cause or alleviate the obstruction

176
Q

what patients show pembertons sign?

A

venous obstruction
goiters
mediastinal mass

177
Q

tracheobronchial compression leads to

A

shortness of breath
orthopnea (when lying down)
total airway obstruction
pinch off ETT

178
Q

intrathoracic mass

A

open on inspiration
collapse on expiration

179
Q

extrathoracic mass

A

collapse on inspiration
open on expiration

180
Q

what diagnostic tests should you order for mediastinal mass?

A

CT
CXR
ECHO
Pulm function test

181
Q

what is the best diagnostic test to assess tracheal compression?

A

CT

<50%

182
Q

at what % of occlusion is there a high risk of complications with GA

A

< 50%

183
Q

what is the best diagnostic test to assess compression of the heart

A

ECHO

184
Q

what do the results of diagnostic tests mean for anesthesia?

A

2 or more significant abnormal findings on CT, spiro, ECHO and there is high risk of complications for GA

185
Q

what should be done to tumor prior to GA, if possible?

A

shrink tumor with steroids or radiation

186
Q

intubation technique mediastinoscopy

A

awake fiberoptic intubation in sitting position
premedication limited to antimuscarinics
armored tube

187
Q

armored tube

A

wire coil to prevent kinking or compression

188
Q

surgical options for airway compression

A

1) laser removal of lesion
2) tracheal/bronchial stent

189
Q

is it better to spontaneous or mechanically ventilate pt with airway stenosis?

A

spontaneously ventilation

190
Q

sternotic airway flow

A

turbulent

191
Q

what does turbulent flow cause?

A

decreased effective gas exchange

192
Q

Why is Heliox used?

A

allows more laminar flow through partial airway obstruction

193
Q

how can you decrease velocity (incr laminar flow)?

A

slow down RR
decr density of gas (Heliox)

194
Q

diagnostic phase airway

A

LMA w/bronchoscope

195
Q

diagnostic phase anesthetic management

A

sevo
lidocaine infusion

196
Q

why is sevo good?

A

bronchodilator
better to mx spontaneous ventilation

197
Q

lidocaine infusion

A

1-2 mg/min
(decrease airway reactivity)

198
Q

ventilation during bronchoscopy

A

1) ventilate with bronchoscope
2) jet ventilation

199
Q

inhalation induction for mediastinoscopy: pros

A

SV

200
Q

inhalation induction for mediastinoscopy: Cons

A

partial obstruction is common
lg neg pressure
airway collapse

201
Q

routine induction for mediastinoscopy

A

pts that show no clinical or radiological evidence of airway or cardio obstruction

202
Q

ventilation with tracheal compression

A

have plan
if distal to obstruction manual ventilation can be attempted
if unsure about distal or proximal then spontaneous should be maintained

203
Q

what should you do if you are unable to place the ETT distal to the obstruction mediastinoscopy

A

tracheal stent used placed with rigid bronchoscopy or jet ventilation (bronchoscopy should be on standby)

204
Q

jet ventilation

A
  • high pressure can be used to ventilated through small catheter
  • allow ventilation past an area of stenosis

“cant intubate, cant ventilate”

205
Q

what anesthetic is required with jet ventilation?

A

TIVA
(no inhalational)

206
Q

how do you turn on the jet ventilator

A

push the lever down

207
Q

manual jet ventilation complications

A

barotrauma
breath stacking
tension pneumothorax

208
Q

what position should the patient be in during mediastinoscopy

A

semi upright position to maintain airway and reduce airway edema

209
Q

what should be avoided in order to maintain cerebral perfusion pressure

A

avoid hypotension

obstructed venous drainage can cause increased ICP and compromise CPP

210
Q

where should you place IVs in a person with SVC syndrome?

A

lower extremities
- if evidence of SVC syndrome

consider preload augmentation

211
Q

what is important to have immediately available during mediastinoscopy?

A

surgical intervention
heart team on standby
groins preped for bypass

212
Q

in what case for mediastinoscopy should the bypass cannulas be placed prior to GA induction

A

all pts with >50% reduction of airway

213
Q

laser lead extraction

A

pacing leads may become infected and need removal
tissues grow around leads
laser sheaths used to remove tissue

214
Q

laser lead extraction precautions

A

aline placed
cardiac team standby

215
Q

laser lead extraction complications

A

could have severe hypotension and hemorrhage

216
Q

Maze procedure

A

treat Afib by inflicting scar tissue to disprupt abnormal conduction pathways

217
Q

how to inflict scar tissue in Maze procedure?

A

incisions
cold temp/cryomaze
abnormal conduction pathways

218
Q

Maze procedure open or endovascular?

A

open chest
- sternotomy
- thoracotomy

(typically combined with other procedures)

219
Q

Left atrial appendage closure

A

prevent clot release from LA in pts with history of Afib during Maze procedure

220
Q

LA appendage open or endovascular?

A

open chest
(typically combined with other procedures0

221
Q

Watchman Device

A

placed in LA appendage to prevent clots from escaping and going to the head and causing a stroke

222
Q

Watchman placement open or endovascular?

A

endovascular

223
Q

gold std for carotid stenosis

A

carotid endarterectomy

224
Q

CEA managment

A

EEG monitoring
<1 MAC
phenylephrine drip
NTG/Cardene
art line

225
Q

when are vasodilators usually required during CEA?

A

emergence to prevent HTN from coughing during extubation

226
Q

Transcarotid Artery Revascularization (TCAR)

A

arterial flow through the carotid artery is reversed and stent deployed

227
Q

TCAR advantages

A

lower chance of stroke
less invasive surgery

228
Q

TCAR anesthetic

A

MAC

Fa: Methods 2 (16 decks)

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