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Summer 2020 - Advanced Anesthesia - CV > Anesthesia for Vascular Surgery - Quiz 4 > Flashcards

Anesthesia for Vascular Surgery - Quiz 4 Flashcards

1
Q

For pts w/ PVD & PAD, how must the MAP change in order to perfuse vital organs?

A

MAP must Increase

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2
Q

Why are ART lines recommended for pts w/ PVD & PAD?

A

Hypotension, even for a little, can cause Ischemia

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3
Q

What are the Major Risk Factors for Abdominal Aortic Aneurysms?

A

Smoking

Old Age

Men > Women

White > Black

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4
Q

How are AAAs diagnosed?

A

Computed Tomography Angiography (CTA)

&

Pulsatile Abdominal Mass

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5
Q

When is Surgical Intervention recommended for AAAs?

A

> 5.5 cm

4.5 w/ >0.5 cm growth in 6 months

Ruptured AAA

Symptomatic AAA

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6
Q

How much do AAAs expand each year?

A

4mm / year

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7
Q

In regards to AAAs, the Wall Tension is _____ proportional to Vessel Radius & Pressure, and ______ proportional to Wall Thickness.

A

In regards to AAAs, the Wall Tension is Directly proportional to Vessel Radius & Pressure, and Indirectly proportional to Wall Thickness.

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8
Q

Which Artery is this?

A

Right Coronary Artery

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9
Q

What are Contraindications to Elective AAA Repair?

A

Intractable Angina

Recent MI

Severe Pulm. Dysfunction

Chronic Renal Insufficiency

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10
Q

What is the most common and preferred site of Abdominal Aortic Aneurysms?

A

Infrarenal

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11
Q

What meds should be given to patients prior to AAA repair to optimize Myocardial Oxygen Supply & Demand?

A

B-Blockers

Statins

Fluid Load

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12
Q

Which EKG leads should be used for AAA repairs?

A

Lead II - Arrythmias

&

Lead V5 - ST Changes

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13
Q

How is Blood Pressure affected by Aortic Cross Clamping?

A

↑BP above Clamp

↓BP below Clamp

↑Afterload

↑SVR

↑MAP

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14
Q

What are pts w/ Poor LV function at risk for with Cross Clamping?

A

CHF

↑Afterload = ↑LV Wall Tension & O2 Demand

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15
Q

Which Artery is this?

A

Right (Acute) Marginal Artery

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16
Q

What is the main factor that causes Cardiac Instability & Depression during Cross Clamping?

A

Release of Archidonic Acid

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17
Q

Aside from Arachidonic Acid, what other substances are released during Cross Clamping?

A

Cytokines

Prostaglandins

Nitric Oxide

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18
Q

What happens to the Heart w/ an Increase in Thomboxane A2 production?

A

↓Contractility

&

↓Cardiac Ouptut

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19
Q

What are symptoms of Mesenteric Traction Syndrome from Cross Clamping?

A

Hypotension

Tachycardia

↑Cardiac Output

Facial Flushing

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20
Q

Which sites of cross clamp have a higher risk for Acute Kidney Injury?

A

Suprenal & Juxtarenal - 80% renal blood flow reduction

(40% w/ Infrarenal)

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21
Q

What can happen if a Suprarenal Cross Clamp is in place over 30 minutes?

A

Post-Op Renal Failure

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22
Q

What meds should be avoided to prevent AKI from Cross Clamping?

A

NSAIDs

Gentamicin

Neomycin

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23
Q

Which arteries supply 20% of Spinal Cord blood flow to the Dorsal/Sensory portion?

A

Posterior Artery x 2

&

Posterolateral Arteries x 2

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24
Q

Which artery is this?

A

Left Coronary Artery

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25
Q

Which artery supplies 80% of the Spinal Cord blood flow to the Motor Portion?

A

Anterior Spinal Artery

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26
Q

Damage to which artery causes Spinal Cord Ischemia?

A

Greater Radicular Artery / Adamkiewicz - tranverse blood flow to spinal cord

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27
Q

What are ways to minimize risk of Spinal Cord Ischemia?

A

CSF Drainage

Mild Hypothermia

Keep SBP > 120 mmHg thru Post Op Day 2

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28
Q

What are the Hemodynamic Changes associated w/ Cross Clamp Release?

A

↓Contractility & Cardiac Output

↓CVP & Venous Return

↓SVR, Preload & Afterload

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29
Q

What causes the Transient Vasodilation w/ Cross Clamp Release?

A

Release of built up Anaerobic Metabolites

Release of Adenine

Tissue Hypoxia

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30
Q

When used, what are the advantages of an Epidural for Open AAA Repair?

A

↓Preload & Afterload

Preserves Cardiac Oxygen

↓Stress Response

↓Pulmonary Problems

Post-Op Pain Control

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31
Q

When used, what are the Disadvantages of an Epidural for Open AAA Repair?

A

Anticoagulation

Hematoma Risk

Severe Hypotension w/ Blood Loss & Cross Clamp Release

32
Q

How are fluids managed w/ an Open AAA Repair?

A

Replace Third Space Loss @ 10mL/kg/hr

Keep Urine Output @ 1mL/kg/hr

Cell Saver

33
Q

Which type of Aortic Aneurysm is at the Renal Artery Level & Spares the Renal Artery Orifice?

A

Juxtarenal Aneurysm

34
Q

Which type of Aneurysm includes at least one Renal Artery & possibly Visceral Vessels?

A

Suprarenal Aneurysm

35
Q

Which artery is this?

A

Circumflex Artery

36
Q

What are the symptoms of a Ruptured Aortic Aneurysm?

A

Severe Abdominal/Back Pain

Altered Level of Consciousness d/t Hypotension

Pulsatile Abdominal Mass

37
Q

Which type of Aortic Aneurysm carry the highest risk for Rupture?

A

Thoracic Aortic Aneurysm

Most commonly caused by Atherosclerosis

38
Q

What are the different types of Thoracic Aortic Aneurysms?

A
  • Fusiform - Spindle Shape w/ Aorta Dilation
  • Saccular - Spherical & Limited to one Segment of Vessel Wall
39
Q

What are the symptoms of a Thoracic Aortic Aneurysm?

A

Pain

Stridor

Cough

Hoarseness

d/t Left RLN Impingement

40
Q

What equipment is needed for a Thoracic Aortic Aneurysm repair located in the Ascending Aorta?

A

Cardiopulmonary Bypass

41
Q

Which type of Aortic Aneurysm is this?

A

Type II

Distal to Left Subclavian Artery & Below Renal Arteries

42
Q

Which type of Aortic Aneurysm is this?

A

Type V

Below 6th ICS to just above Renal Arteries

43
Q

Which type of Aoritc Aneursym is this?

A

Type I

Distal to Left Subclavian Artery & Above Renal Arteries

44
Q

Which type of Aortic Aneursym is this?

A

Type IV

From 13th ICS to Iliac Bifurcation (Entire Abdominal Aorta)

45
Q

Which type of Aortic Aneurysm is this?

A

Type III

From 6th ICS to Renal Arteries

46
Q

Which artery is this?

A

Left (Obtuse) Marginal Artery

47
Q

Where should the A-Line be placed if the Aneurysm is in the Thoracic Region or Distal Aortic Arch?

A

Right Radial

48
Q

What are Lumbar Intracthecal Catheters used for in regards to Thoracic Aneurysm Repair?

A

Monitoring CSF Pressure & Drainage

SSEP

MEP

49
Q

How Spinal Cord Perfusion pressure measured?

A

Spinal Cord Perfusion Pressure = MAP - CSF Pressure

50
Q

How does Cross Clamping affect CSF Pressure

A

Increases CSF Pressure

&

Decreases Arterial Pressure distally

51
Q

What is the Goal CSF Pressure during Cross Clamping?

A

CSF Pressure < 10 mmHg

52
Q

What is an Aortic Dissection?

A

Spont. tear of vessel w/ blood passing along a false lumen

HTN worsens it

53
Q

What is a DeBakey Type I Aortic Dissection?

A

From Ascending Aorta to Aortic Arch & often into Descending Aorta

54
Q

What is a DeBakey Type II Aortic Dissection?

A

Confined to Ascending Aorta

55
Q

What is a DeBakey Type III Aortic Dissection?

A

From Descending Aorta just distal to Left Subclavian Artery & Extends Distally

56
Q

What is a Stanford Type A Aortic Dissection?

A

Involves Ascending Aorta

57
Q

What is a Stanford Type B Aortic Dissection?

A

Dissections that do NOT involve Ascending Aorta

58
Q

Which artery is this?

A

Left Anterior Descending Artery

59
Q

How is an Endovascular Aortic Aneurysm Repair done?

A

Guidewire thu Bilateral Fem Arteries to the Aneurysm, then Sheath over guidewire and Deploy Stent from Sheath

60
Q

What are complications to an EVAR?

A

Failed Deployment
Microemolization
Stent Migration
Aortic Perf
Hematoma
Endoleak
Graft Tear, Stenosis, Thrombosis
Access Artery Damage
Infection
Kidney Injury d/t Contrast
Radiation Exposure

61
Q

What is a Type I Endoleak?

A

Attachment Site Leaks

Fix w/ Graft Extension, Second Graft or Open Repair

62
Q

What is a Type II Endoleak?

A

Branch Leaks

Monitor or Fix w/ Lap Clip or Embolization

63
Q

What is a Type III Endoleak?

A

Graft Defect (Tear, Disconnect)

Fix w/ Second Graft or Open Repair

64
Q

What is a Type IV Endoleak?

A

Graft Porosity or Suture Holes

Fix w/ Second Graft or Open Repair

65
Q

When are Carotid Endarterectomies (CEA) indicated?

A

Carotid Stenosis > 70%

66
Q

What are symptoms of Carotid Stenosis?

A

TIA/Stroke

Carotid Bruit

Monocular Blindness

67
Q

What factors increase Morbidity risk for CEAs?

A

Stroke Hx

Hyperglycemia

Old Age

Multiple Comorbidities

Ulcerative Lesion

68
Q

Which artery is this?

A

Diagonal Arteries

69
Q

How is Cerebral Pefusion Pressure measured?

A

CPP = MAP - ICP

70
Q

At what MAP is Cerebral Autoregulation constant?

A

MAP 60 - 160 mmHg

71
Q

What causes Cerebral Steal?

A

Hypercarbia -> cerebral vasodilation –> Ischemia

72
Q

When would Ischemia be a concern when measuring Cerebral Oximetry?

A

A decrease > 20% during CEA

73
Q

What should the pts MAP be during Carotid Cross Clamping?

A

20% or more w/ a goal SBP > 160 mmHg

After Clamp Removal: SBP < 140 mmHg

74
Q

If a CEA is done under regional, which nerve would you want to block?

A

Deep & Superficial Cervical Plexus Block for Cranial Nerves II-IV

75
Q

Which volatile agent should not be used for CEAs?

A

Avoid N2O - Pneumocephalus Risk

76
Q

What are the Post Op CEA Complications?

A

HTN - most common

Cerebral Hyperperfusion Syndrome
(Headache, Vision Problems, LOC, Seizures)

Hemodynamic Instability

Stroke

Resp Insufficiency

Cardiac Ischemia

PTX

77
Q

What are the complications of Carotid Stenting?

A

Stroke - Most Common

MI

Bradycardia & Hypotension

Horner’s Syndrome

Cerebral Hyperperfusion

Carotid Dissection

Hemorrhage

Summer 2020 - Advanced Anesthesia - CV (9 decks)

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