Abdominal Aortic Aneurysm

Question 1

How do you set up the OR for a AAA? (5)

Answer 1

Large ETT

Transducers (double or triple)- Art, Swann, Central lines

Fluid warmers

NG tube

Albumin available?

Question 2

What drugs do you need during a AAA?

Uppers (3)
Downers (3)

Answer 2

Uppers: Norepi, Epi, Vasopressin

Downers: NTG, Nicardipine, Esmolol

Question 3

What does high creatinine indicate?

Answer 3

Renal insufficiency

Question 4

For patients with a pacemaker, what do you need to do?

Answer 4

Need magnet to place on the device.

Question 5

What is the normal diameter of the abdominal aorta?

Answer 5

3 cm

Question 6

What do you need to ensure regarding blood prior to surgery?

Question 7

What lab value is important because end organ issues can become a major complication during surgery?

Answer 7

Creatinine!

Question 8

What induction drugs do you use for renal/heart patients?

Answer 8

Etomidate 20mg

Fentanyl 250 mcg

Cisatracurium 8mg

Question 9

What are the 3 phases of an AAA?

Answer 9

Dissection

Clamping/Surgical Repair

Unclamping

Question 10

What hemodynamic effects does clamping present?

Answer 10

Increased BP!!

Question 11

What hemodynamic changes does surgical repair present?

Answer 11

Decreased BP!

Question 12

PEARL

How do you quickly calculate PaO2?

Answer 12

FiO2 * 5

Question 13

What does clamping do to afterload?

Answer 13

Increases it.

Question 14

During clamping phase, what do you need to do? (2)

Answer 14

Check urine output often to ensure renal perfusion!

Turn off lower body Bair hugger to decrease metabolism/O2 requirement!

Question 15

What is normal urine output?

Answer 15

0.5 - 1.5 cc/kg/hr

Question 16

When clamping, what 2 drugs should be in line?

Answer 16

NTG–reduces preload

Nicardipine

Question 17

What lab value can you expect to change when giving albumin?

Answer 17

Calcium decreases.

Note: Also occurs with cell saver.

Question 18

What does a (-) BE indicate?

Answer 18

Acidic state

Question 19

When unclamping, what should you do? (3)

Answer 19

Take downers out of line!

Pressors in line.

Give fluids– use pressurized bag.

Question 20

What should you do if the pt becomes unstable during unclamping?

Answer 20

Reclamp and reassess.

Question 21

During closing, what should we do? (5)

Question 22

What are common post-op complications? (7)

Answer 22

MI, arrhythmia (50% of complications)

Renal failure/insufficiency

Ileus

Ventilation problems (TRALI related)

Pain

Bleeding

Multiorgan failure