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APA/Foundations 2 > Anesthesia for Vascular Surgery - Quiz 4, Part 1 > Flashcards

Anesthesia for Vascular Surgery - Quiz 4, Part 1 Flashcards

1
Q

Most common cause of occlusive dz

A

Atherosclerosis

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2
Q

Most common cause of occlusive dz in the lower extremity

A

Periph Vasc Dz

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3
Q

Pathophys of PVD

A
  1. Plaque formation
  2. Thrombosis
  3. Embolism from micro thrombi or atheromatous debris
  4. Aneurysm formation
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4
Q

Major risk factors in the pathogenesis of atherosclerosis in the peripheral vascular system

A
  1. Cigarette Smoking

2. DM

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5
Q

What provides alternative vast blood flow in its w occlusive dz?

A

development of collateral circulation

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6
Q

From what does more than half of the mortality associated w PVD result?

A

adverse cardiac events

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7
Q

How long before surgery (specifically AAA repair) should B-blockers be started to decease risk for myocardial ischemia and infarction?

A

days to weeks before surgery

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8
Q

What target heart rate should B-blocker therapy be titrated to?

A

50-60 bpm

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9
Q

Because of their antiinflammaory effects, statin drugs should be instituted ____ days prior to the surgical procedure

A

30 days

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10
Q

T/F: Preop, the greater number of comorbidities that exist, the treater the risk of morbidity and mortality during the peri-op period.

A

True

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11
Q

Typical symptoms of PVD

A
  1. Claudication
  2. Skin ulceration
  3. Gangrene
  4. Impotence
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12
Q

What primarily influences the extent of the disability from PVD?

A

development of collateral blood flow

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13
Q

Mortality rates of PVD are _____ times higher than the general population.

A

2-6x higher

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14
Q

Primary objective of monitoring during surgery on a pt w PVD

A

Detection of myocardial ischemia

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15
Q

Should MAP be kept high or low in a pt with HTN and/or angiopathy? Why?

A

Higher

these pos depend on MAP to perfuse their vital organs

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16
Q

Does the range of auto regulation pressures change in an angiopathy or HTN pt?

A

Yes. Cerebral and coronary auto regulation occurs at higher than normal pressures

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17
Q

Why is intraarterial BP monitoring warranted during surgery on a pt w vasc dz?

A

Dramatic fluctuations in BP can occur during anesthesia

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18
Q

What should be expected in a pt with atherosclerotic occlusive dz?

A

Expect that the disease is elsewhere also, specifically in the coronary, cerebral, and renal arteries

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19
Q

Why is B blocker therapy recommended in its w a high risk of myocardial ischemia and infarction?

A
  1. decreases myocardial O2 demand

2. brings supply-demand system into balance

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20
Q

Single most significant risk factor influencing long-term survivability in a pt who requires abd aortic reconstruction

A

Presence of underlying CAD

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21
Q

Most reliable definition of coronary anatomy and the extent of CAD

A

Coronary angiography

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22
Q

Reliable method for evaluating the extent of myocardial dysfx associated with CAD and for predicting coronary events after vast surgery; does not rely on exercise for detection of areas of myocardial hypoperfusion

A

Dipyridamole thallium testing

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23
Q

Goal of al prep cardiac evaluation

A

ID fx cardiac limitations

24
Q

Common coexisting diseases in pts presenting for abd aortic resection

A
  1. HTN
  2. Heart dz
  3. COPD
  4. DM
  5. Renal impairment
  6. CAD
25
Q

T/F: postoperative admin of narcotics after vascular surgery not only provides pt comfort but also contributes to cardiac stability.

A

True

26
Q

Why are epidural opioid and local anesthetics an important component in pts recovering from vascular surgery?

A

Pain can enhance sympNS stimulation

27
Q

Risk factor most highly correlated with AAA

A

Smoking

Smokers have a 5-8 fold increase in AAA incidence

28
Q

What is thought to be the primary cause of AAA in 90% of pts?

A

Atherosclerosis

29
Q

AAA Contributing factors

A
  1. Atherosclerosis
  2. Proteolysis of elastin and collagen within a vessel wall
  3. HTN
  4. Cigarette smoking
  5. Genetic predisposition
  6. Obesity - may mask s/s
30
Q

One of the most frequent vascular surgical procedures

A

Elective AAA repair

31
Q

Risk of rupture is very low for AAAs less than ___cm in diameter

A

<4 cm

32
Q

Risk of rupture dramatically increases for AAAs with a ____ cm or greater diameter

A

> /= 5 cm

33
Q

Criteria for AAA surgical intervention

A
  • AAA >/= 5.5 cm
  • Ruptured AAA
  • 4-5 cm AAA w >0.5 cm enlargement in < 6 mo
  • symptomatic AAA
  • elective repair of AAA >/+ 5.o cm
34
Q

T/F: Age alone is not a contraindication to elective aneurysmectomy

A

True

35
Q

Contraindications to elective repair of AAA

A
  1. Intractable angina pectoris
  2. Recent MI
  3. Severe pulm dysfx
  4. Chronic renal insufficiency
36
Q

Do its with stable CAD and coronary artery stenosis of >70% who require non emergent AAA repair benefit from revascularization if B-blockade has been established?

A

No. They do not benefit.

37
Q

Most common reason for poor outcomes in non cardiac surgery

A

Peri-op MI

38
Q

What are the 2 major goals of per-op risk reduction?

A
  1. Optimization of myocardial O2 supply and demand

2. Modification of cardiac risk factors

39
Q

Hallmark pharmacologic tx for medical mgmt of AAA

A
  1. B-blockers
  2. Statins
  3. ASA
40
Q

Most important techniques used to enhance cardiac fx during abd aortic aneurysmectomies

A
  1. Pre-op fluid loading

2. Restoration of intravasc vol

41
Q

Standard monitoring methods for AAA repair

A

ECG - leads II and V5
Pulse ox
Capnography
Indwelling urinary catheter

42
Q

Which has higher sensitivity and specificity in detecting myocardial ischemia, PAC or TEE?

A

TEE

43
Q

Primary method of interaction-op cardiac assessment in its undergoing surgery on the heart and aorta

A

TEE

44
Q

What occurs sooner during periods or reduced coronary blood flow, wall motion abnormalities or EKG changes?

A

Wall motion abnormalities

45
Q

Greatest risk of mortality after abd aortic reconstruction

A

Myocardial Ischemia

46
Q

The most common site for aorta cross-clamping. Why?

A

Infrarenal

Most aneurysms appear below the level of the renal arteries

47
Q

How do hemodynamics change on each side of an aortic cross clamp?

A

HTN above the clamp

HoTN below the clamp

48
Q

During aortic cross clamp (AoX), what causes myocardial wall tension to increase?

A

increase in after load

49
Q

How do MAP and SVR change during AoX?

A

they both increase

50
Q

How does CO change during AoX?

A

it decreases or remains unchanged

51
Q

How does PAOP change during AoX?

A

increases or stays the same

52
Q

True or False: Infrarenal clamping always causes an increase in preload.

A

False.

It depends on splanchnic vascular tone. if blood is shifted into splanchnic circulation, preload will not increase.

53
Q

What 2 things determine if CO increases during AoX?

A

coronary flow and contractility

increased coronary flow and contractility = increased CO
no increase in coronary flow and contractility = decreased CO

54
Q

Synthesis of __________, which is accelerated by the application of an AoX, may be responsible for the decrease in myocardial contractility and CO that occurs.

A

Thromboxane A2

55
Q

Syndrome characterized by

  • decrease in BP and SVR
  • tachycardia
  • increased CO
  • facial flushing
A

Mesenteric traction syndrome

APA/Foundations 2 (6 decks)

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