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Principles semester 2 > Anesthesia for aortic procedures and other vascular procedures > Flashcards

Anesthesia for aortic procedures and other vascular procedures Flashcards

mindy

1
Q

Biggest risk factors for vascular disease

A
  1. smoking
  2. diabetes
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2
Q

mortality rate in patients with vascular disease compared to gen pop

A

2-6 times greater than gen pop

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3
Q

AAA risk factors

A

age
smoking
increased height

elective AAA is most frequent vascular surgical procedure

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4
Q

Surgical intervention of AAA is indicated when

A

> 0.5cm increase in less than 6 months or symptomatic patients and 5.0 cm or greater

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5
Q

important equipment for AAA

A
  1. Foley (monitor for kidney hypoperfusion)
  2. vasoactive gtts
  3. blood tubing and blood
  4. SSEP or MEP for ischemia monitoring
  5. air wamring device
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6
Q

AAA BP and HR monitoring goals

what do you want for BP and HR?

A
  1. BP within 20% of baseline
  2. HR conrolled avoid tachycardia
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7
Q

Why is renal preservation so important? (AAA) - think of clamping causing kidney ischemia

A

mortality rate is 4-5 times higher in pts that develop AKI

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8
Q

Urine output should be (AAA)

A

0.5-1.0 mL/Kg/hr

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9
Q

the best assessment of fluid status is via

A

TEE

need to keep pt hydrated

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10
Q

Clamp causes (strain)

A

Acute left ventricular strain

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11
Q

BP above clamp is

A

hypertension

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12
Q

BP below clamp is

A

hypotensino

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13
Q

Spinal cord ischemia during AAA clamp

A

interruption of blood flow to greater radicular artery (artery of Adamkeiwicz)

can cause paraplegia

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14
Q

Ways to reduce risk of spinal cord ischemia

A

SSEP/MEP
short clamp time
higher perfusino pressures
CSF drainange

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15
Q

AAA incidence of renal dysfucntion

A

10-20%

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16
Q

MAP should be ____ to decrease risk of renal dysfunction in AAA

A

MAP of 60 or greater is warranted

and decreased clamp time

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17
Q

AAA unclamping

A

prepare for hypotension

18
Q

AAA rupture classic triad

A

becks triad:
1. hypotension
3. back pain
3. abdominal pulsatile mass

19
Q

for a dissecting AAA,what should you have and anesthetic considerations

A

have blood
2 large IVS
art line
RSI/full stomach prepared

20
Q

Resection of ascending aorta and graft replacement will need (thoracic AAA)

A

CPB

21
Q

most commone aortic aneurysm repaire

A

endovascular

22
Q

PVD risk factores

A

age
HTN
tobacco
diabetes family history

23
Q

Renal artery stenosis

what is it?
what happens as a result?
S/sx
What is usually the cause?

A

usually caused by atherosclerosis

causes activation of renin-angiotensin system = vasoconstriction, sodium retention, hypertension

24
Q

Aortoiliac occlusive disesae

what is it, what happens

A

circulatory problems in the lower extremities, claudication

s/sx: diminishd/absent pedal pulses, decreased capillary refill

25
Q

Visceral artery stenosis

what is it,
who is at risk?
What most often causes it?

A

causes “intestinal angina” = weight loss

more common in women*

often from athersclerosis

26
Q

Takayasu’s arteritis

what is it?
who is at risk?
What does it usually affect?

A

progressive occlusive vasculitis of LARGE VESSELS

Asian women <40 years

usually affects aorta + branches

27
Q

Takyasu’s arteritis anesthetc considerations

A
  1. caution with head extension*
  2. seteroid therapy
  3. anticoagulation
  4. positioning
  5. keep BP normal or slightly eleveated
28
Q

Tromboangiitis abliterans aka

A

Buerger’s disease

29
Q

Thromboangiitis Obliterans/ Buerger’s disease

what is it?
what is it associated with as a risk factor?

A

Occlusion of medium and small vessels of extremities

usually associated with tobacco use

30
Q

Wegners granulomatosis

what is it and what is it associated with

A

Necrotizing granulomas in inflamed vessels

Pts are usually on chronic steroids

can be in airway!

31
Q

Wegner’s important anesthetic consideration

A

can be in airway and cause airway narrowing

multiple organ involvement

32
Q

Temporal arteritis

what is it, treatment, anesthesia considerations

A

inflammation of arteries in head and neck

Treatment: corticosteroids

anesthetic considerations: Steroids, careful positioning

33
Q

Polyarteritis Nodosa

What is it?
Where is it usually and where else could it be?
What is it associated with as a possible risk factor?

A

Vasculitis involving small and medium sized arteries

especially kidneys

associated with Hep B infection

34
Q

Polyarteritis Nodosa anesthetic considerations

A

-Consider renal or cardiac involvement
-pt may be on steroids
-HTN usually present

35
Q

Henoch-Schonlein Purpura

what is it, who/when does it occur

A

Inflammation of the arterioles and capillaries of the skin, kidneys, GI tract, large joints

common in kids, especially following a respiratory infection

36
Q

Kawasaki disease

what is it, who gets it,

A

Vasculitis involvement of coronary arteries

Occurs in kids, believed to be caused by a non-contagious infections

37
Q

Raynaud phenomenon

anesthetic considerations

A

Episodic vasospastic ischemia of the digits

considerations:
-careful with vasoconstrictors (phenyl)
-Keep warm (triggered by cold)
-careful positioning

38
Q

Moyamoya disease

who gets it and what happens

A

Rare, progressive disease of kids and young adults

occlusion of internal carotid, middle and anterior

39
Q

Moyamoya anesthesia consideration

A
  1. preserve CBF
  2. keep them deep
  3. Keep BP in tight range
40
Q

Klippel-Trenaunay-Weber syndrome

what is it, anesthetic considerations

A

“Local gigantism” venous malformations of extremities, neck, trunk

Anesthetic considerations:
No neuraxial blockade due to spinal AVMs

41
Q

Bechet’s disease

what is it, treatment, anesthesia consideration

A

Relapsing inflammatory disorder causing oral, genital, and GI ulcers and uveitis

tx: steroids

consideratsions:
-positioning
-steroid stress dose
-neuro exam

42
Q

AV fistula formation

how do we do it? What is necessary? Anesthetic considerations

A

Upper extremity vessels
Use 5000-8000 units of heparin

anesthetic consideration: can usually be performed under MAC/regional

Principles semester 2 (17 decks)

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