Anesthetic Management for AAA

Question 1

What are 6 significant risk factors for post-op cardiac events?

Answer 1

high risk surgery

ischemic heart disease

Creatinine > 2.0

Hx TIA, CVA

Type I diabetes

Hx of CHF

Question 2

What are 3 noninvasive cardiac evaluations we can perform?

Answer 2

Stress test

Dipyridamole-Thallium Stress test

Dobutamine Stress Echo

Question 3

What are severe cardiac risk factors? (4)

Answer 3

Recent MI
Decompensated heart failure
Significant arrhythmias
Severe valvular disease

Question 4

What are moderate cardiac risk factors? (5)

Answer 4

Ischemic heart disease
Compensated CHF
DM
Renal insufficiency
Cerebrovascular disease

Question 5

What are high risk surgeries? (4)

Answer 5

Emergent surgery
Aortic/major vascular surgery
Peripheral vascular surgery (leg amputation)
Prolonged surgery with large fluid shifts/blood loss

Question 6

What are considered intermediate risk surgeries? (5)

Answer 6

Carotid endarterectomy
Head/neck
Thoracic/Abdominal
Orthopedic
Prostate

Question 7

If functional capacity is < 4 mets and >3 risk factors, do you proceed with intermediate risk surgery?

Answer 7

Yes, with HR control or consider testing if it will change management.

Question 8

When is CABG indicated? (4)

Answer 8

Stable angina w/ left main stenosis
Stable angina and 3-vessel CAD
Stable angina and 2-vessel CAD with LAD
Unstable angina or acute MI

Question 9

What type of monitoring is required for AAR (abdominal aortic reconstruction)? (6)

Answer 9

All cases need:

ASA standard monitors
2 Large bore IVs
Art line

Good LV, need central line

Poor LV, need PA line and TEE

Question 10

Renal effects significant even infrarenally!

What are the renal effects of infrarenal aortic cross clamping?

Answer 10

decreased renal blood flow

increased renal vascular resistance

reduced GFR

Note: Changes persis for at least 1 hour after unclamping.

Question 11

During thoracic aorta repair, what is at risk of ischemia?

Answer 11

spinal cord, so drain prior to surgery

Question 12

Asymptomatic bruit/stenosis does not increase the stroke risk for general surgery. True or false?

Answer 12

true

Question 13

What are the neurological risks for carotid endarterectomies? (6)

Answer 13

irregular/ulcerated ipsilateral plaque
thrombus
poor colllaterals
contralateral occlusion
STATINS
history of stroke

Question 14

When is the highest risk of embolism during a carotid endarterectomy? (4)

Answer 14

dissection

shunt insertion

clamp release

12 hours post op

Question 15

What issues can arise after a carotid endarterectomy? (7)

Answer 15

Hyper, hypotension
Carotid body damage
MI
Stroke
Hyperperfusion
Neck hematoma
Cranial nerve injury