Anesthesia for cardiac surgery Flashcards
Goals of cardiac surgery
optimizing myocardial supply and demand are the goals of the surgery
Gold standard for diagnosis of cardiac pathology
heart cath results
Place art line
in pre op or or PRIOR TO INDUCTION
Subclavian vein depth
10 cm
Right EJ depth
10 -15 cm
Right IJ depth
15-20 cm
Femoral depth
35-40 cm
RAC depth
40 cm
LAC deph
50 cm
Most sensitive clinica monitor for detection wall motion abnormalities
TEE
Heparin cardiac surgery setup
400-400 units/kg ready but not drawn up
High stimulation pre-bypass times
- incision
- sternotomy
- sympathetic nerve dissection and opening of pericardium
Low stimulation pre bypas times
Harvesting
ACT should be checked
3 min after heparinA
ACT for bypass should be
greater than 400
Aortic canulation BP
SBP needs to be 100-90 mmHG
or
MAP < 70
to prevent dissection
RAP
retrorade autologous priming
causes hypotension, blood pressure will need to be elevated
On bypass, ACT should be
> 400-450
CPB is iniated when
perfusionists release the clamp that occludes the tubing connectin the venous cannula to the venous reservoir
arterial filter pore size (CPB)
21-40um
Cardioplegia role and active ingredient
stops myocardial contraction
primary active ingredient: potassium chloride
Components of Cardioplegia
- KCL 10-40 mEq/L
- Sodium <140 mEq/L
- Calcium chloride (cellular integrity)
- bicarb (metabolic buffer)
- mag sulfate (regulates Ca influx, antiarrhythimic)
- glucose, insulin, glutamate
Maybe: - nitroglycerin, mannitol, lidocaine
Methods of cardoplegia (3)
- antegrade (aortic root)
- down each vein graft (after distal anastamosis)
- retrograde (coronary sinus)
body temp cooled to (CPB)
20-32 deg c
