Anesthesia for aortic procedures and other vascular procedures Flashcards
mindy
Biggest risk factors for vascular disease
- smoking
- diabetes
mortality rate in patients with vascular disease compared to gen pop
2-6 times greater than gen pop
AAA risk factors
age
smoking
increased height
elective AAA is most frequent vascular surgical procedure
Surgical intervention of AAA is indicated when
> 0.5cm increase in less than 6 months or symptomatic patients and 5.0 cm or greater
important equipment for AAA
- Foley (monitor for kidney hypoperfusion)
- vasoactive gtts
- blood tubing and blood
- SSEP or MEP for ischemia monitoring
- air wamring device
AAA BP and HR monitoring goals
what do you want for BP and HR?
- BP within 20% of baseline
- HR conrolled avoid tachycardia
Why is renal preservation so important? (AAA) - think of clamping causing kidney ischemia
mortality rate is 4-5 times higher in pts that develop AKI
Urine output should be (AAA)
0.5-1.0 mL/Kg/hr
the best assessment of fluid status is via
TEE
need to keep pt hydrated
Clamp causes (strain)
Acute left ventricular strain
BP above clamp is
hypertension
BP below clamp is
hypotensino
Spinal cord ischemia during AAA clamp
interruption of blood flow to greater radicular artery (artery of Adamkeiwicz)
can cause paraplegia
Ways to reduce risk of spinal cord ischemia
SSEP/MEP
short clamp time
higher perfusino pressures
CSF drainange
AAA incidence of renal dysfucntion
10-20%
MAP should be ____ to decrease risk of renal dysfunction in AAA
MAP of 60 or greater is warranted
and decreased clamp time
AAA unclamping
prepare for hypotension
AAA rupture classic triad
becks triad:
1. hypotension
3. back pain
3. abdominal pulsatile mass
for a dissecting AAA,what should you have and anesthetic considerations
have blood
2 large IVS
art line
RSI/full stomach prepared
Resection of ascending aorta and graft replacement will need (thoracic AAA)
CPB
most commone aortic aneurysm repaire
endovascular
PVD risk factores
age
HTN
tobacco
diabetes family history
Renal artery stenosis
what is it?
what happens as a result?
S/sx
What is usually the cause?
usually caused by atherosclerosis
causes activation of renin-angiotensin system = vasoconstriction, sodium retention, hypertension
Aortoiliac occlusive disesae
what is it, what happens
circulatory problems in the lower extremities, claudication
s/sx: diminishd/absent pedal pulses, decreased capillary refill
Visceral artery stenosis
what is it,
who is at risk?
What most often causes it?
causes “intestinal angina” = weight loss
more common in women*
often from athersclerosis
Takayasu’s arteritis
what is it?
who is at risk?
What does it usually affect?
progressive occlusive vasculitis of LARGE VESSELS
Asian women <40 years
usually affects aorta + branches
Takyasu’s arteritis anesthetc considerations
- caution with head extension*
- seteroid therapy
- anticoagulation
- positioning
- keep BP normal or slightly eleveated
Tromboangiitis abliterans aka
Buerger’s disease
Thromboangiitis Obliterans/ Buerger’s disease
what is it?
what is it associated with as a risk factor?
Occlusion of medium and small vessels of extremities
usually associated with tobacco use
Wegners granulomatosis
what is it and what is it associated with
Necrotizing granulomas in inflamed vessels
Pts are usually on chronic steroids
can be in airway!
Wegner’s important anesthetic consideration
can be in airway and cause airway narrowing
multiple organ involvement
Temporal arteritis
what is it, treatment, anesthesia considerations
inflammation of arteries in head and neck
Treatment: corticosteroids
anesthetic considerations: Steroids, careful positioning
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?
Vasculitis involving small and medium sized arteries
especially kidneys
associated with Hep B infection
Polyarteritis Nodosa anesthetic considerations
-Consider renal or cardiac involvement
-pt may be on steroids
-HTN usually present
Henoch-Schonlein Purpura
what is it, who/when does it occur
Inflammation of the arterioles and capillaries of the skin, kidneys, GI tract, large joints
common in kids, especially following a respiratory infection
Kawasaki disease
what is it, who gets it,
Vasculitis involvement of coronary arteries
Occurs in kids, believed to be caused by a non-contagious infections
Raynaud phenomenon
anesthetic considerations
Episodic vasospastic ischemia of the digits
considerations:
-careful with vasoconstrictors (phenyl)
-Keep warm (triggered by cold)
-careful positioning
Moyamoya disease
who gets it and what happens
Rare, progressive disease of kids and young adults
occlusion of internal carotid, middle and anterior
Moyamoya anesthesia consideration
- preserve CBF
- keep them deep
- Keep BP in tight range
Klippel-Trenaunay-Weber syndrome
what is it, anesthetic considerations
“Local gigantism” venous malformations of extremities, neck, trunk
Anesthetic considerations:
No neuraxial blockade due to spinal AVMs
Bechet’s disease
what is it, treatment, anesthesia consideration
Relapsing inflammatory disorder causing oral, genital, and GI ulcers and uveitis
tx: steroids
consideratsions:
-positioning
-steroid stress dose
-neuro exam
AV fistula formation
how do we do it? What is necessary? Anesthetic considerations
Upper extremity vessels
Use 5000-8000 units of heparin
anesthetic consideration: can usually be performed under MAC/regional
