Abdominal Aortic Reconstruction Flashcards
what are 6 significant risk factors for post-op cardiac events?
- high risk surgery
- ischemic heart disease
- creatinine >2.0 mg/dl
- hx TIA or CVA
- type I DM
- hx CHF
how many risk factors make a PT considered “elevated risk”?
2 or more
what would indicate an ECG prior to a surgery?
any heart surgery, especially if pre-excisting structural heart disease.
*not for low risk surgery
when would surgery require an echo (TEE) in the pre-op assessment?
- PTs with dyspnea
- PTs with previous LV dysfunction documented over a year ago
what are considered “active cardiac conditions”?
- recent MI
- decompensated heart failure
- significant arrhythmias
- severe valvular disease
when is a CABG indicated?
- stable angina w
- L main stenosis
- 3 vessel CAD
- 2 vessel CAD with LAD stenosis and EF
how long should you delay an elective surgery after a balloon angioplasty?
14 days
B-blocker use (Metoprolol) peri-op increased the risk for what?
stroke
- 4.3x preop metoprolol
- 3.3x intraop metoprolol
B-blockers shown to reduce the rate of acute cardiac events for who?
PTs with CAD undergoing high risk surgery
should you continue B-blockers if the PT is already on them peri-op?
yes
how should B-blockers be managed after surgery?
by clinical circumstances
*independent of when BB started
who may need a beta blocker pre-op who isn’t already on one?
intermediate or high risk MI on preop testing PTs
*should not be started day of surgery
should statins be continued for PTs taking them?
yes, for noncardiac cases
when would it be reasonable to initiate statin treatment on a PT?
- undergoing vascular surgery
- elevated-risk procedures
ACE inhibitors or ARBs prior to surgery?
typically no, reasonable to restart them as soon as clinically feasible tho
what monitors/access should we have for an AAR?
always - ASA standard - large IV - a-line sometimes - CVL (good LV fx) - PA cath (poor LV fx) - TEE (poor LV fx and cardiac DX)
for PTs undergoing aortic aneurysm repair, are fluid requirements greater or less?
greater
renal blood flow is reduced with AAR clamping, for how long after unclamping?
1 hour, monitor urine output
*may need to use mannitol or furosemide
what would you see with anterior spinal cord eschemia?
- loss of motor function
- loss of pain and temp sensation
what would you see with posterior spinal cord eschemia?
- loss of proprioception and fine touch
what are some considerations for open thoracic aneurysm repair?
- ascending aneurysms require cardiac bypass
- axilo-fem bypass for descending TAA
- keep CSF less than 10 mmHg
- steroids to protect spinal cord
- evoked potential monitor of spinal cord
- double lumen tube
how much does an asymptomatic bruit/stenosis increase stroke risk for gen. surgery?
it doesn’t
what is the carotid shunt during a CEA for?
allows cerebral blood flow during clamp.
*risk of emboli or distal dissection
what does hyperperfusion syndrom look like?
- ipsilateral headache
- seizures
- focal neurologic signs
when should you have high and low perfusion during AAR?
high perfusion before and during cross clamp
- low perfusion after unclamping
what should you look for postoperatively?
- hypotension
- neck hematoma
- hyperperfusion syndrome
what are risk factors for hyperperfusion syndrome?
- severe ICA stenosis
- hypertension
- contralateral ICA stenosis
