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Vascular Anesthesia > Barash Vascular > Flashcards

Barash Vascular Flashcards

1
Q

Generalized inflammatory disorder of the arterial tree with associated endothelial dysfunction

A

Atherosclerosis

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2
Q

With a coronary stent, continue mono therapy with ASA,

you can discontinue plavix for as short a time interval as possible for pts with bare mental stents 1 year

A

…

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3
Q

What are vascular surgery patients at HIGH risk for postoperatively?

A

postop nervous system disease, delirium, stroke, spinal cord ischemia

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4
Q

Which treatment modality is best for a large AAA depends on what 3 variables?

A

AAA size, AAA morphology, patient preoperative risk

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5
Q

EVAR is considered for pts with smaller AAAs.

A

…

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6
Q

EVAR has a lower perioperative risk than OAR but similar

A

2 year mortality

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7
Q

What is the most common cause of emergency aortic repair?

A

Leaking or ruptured aortic aneurysm.

Ruptured aortic aneurysm carry an associated mortality roughly 10 times greater than elective repair.

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8
Q

EVAR stands for

A

endovascular abdominal aneurysm repair

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9
Q

PAD

A

peripheral arterial disease (atherosclerosis affecting the limb and can develop into claudication or critical limb ischemia

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10
Q

PAD affecting the lower limb can be detected by the

A

ANKLE BRACHIAL INDEX: The ratio of the highest systolic ankle bp to the highest sys arm bp. It is the single best initial screening test to perform in a pt suspected of having PAD. Ratio <0.4 is associated with limb threatening ischemia.

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11
Q

What is the standard method for diagnosis the PAD?

A

catheter based angiography

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12
Q

AAA: risk of rupture

A

</- 4cm in diameter = very low

AAA between 4 and 5 cm in diameter should be followed every 6-12 months to determine whether they are increasing in size

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13
Q

Medical therapy for atherosclerosis: the use of statins may reduce progression or even cause regression of atherosclerotic plaques, improve endothelial function and reduce cardiovascular events in high risk pts. It is associated with improved graft latency, limb salvage and decorated amputation rate in pts undergoing infrainguinal bypass for AVD.

A

..

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14
Q

First __ wks after coronary stent placement, non cardiac survey carries considerable risks.

A

6 wks

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15
Q

What ar ethe two basic types of stents?

A

bare metal stents and drug eluting stents

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16
Q

Tell me about drug eluting stents?

A

They have a reduced incidence of restenosis, slow to endothelialize, and the exposed stent material remains thrombogenic far longer than bare metal stents

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17
Q

what is dual anti platelet therapy?

A

aspirin 325mg/day and clopidogrel 75mg/day

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18
Q

What is the duration of dual antipaltelet therapy for bare metal stent and drug eluting stent?

A

bare metal stent: 1 month
drug eluting stent: 365 days (12 months (1year))
*aspirin is rec for an indefinite period

19
Q

If plavix can’t be used for a year, recommendations for DOT are as follows: _ months for sirolimus eluting stents and _ months for paclitaxel eluting stents

A

3 months for sirolimus eluting stents

6 months for paclitaxel eluting stnets

20
Q

what are the two types of PMI (preoperative myocardial infarction)?

A

early and delayed

21
Q

Early PMI resembles …

A

acute nonsurgical MI and is probably due to acute coronary occlusion resulting from plaque rupture and thrombosis .

22
Q

Delayed PMI is associated with.. .

A

SUSTAINED ELEVATION of HR, ABSENCE of CP, prolonged premonitory episodes of ST segment depression before over MI

23
Q

New definition of MI

A

requires the rise and fall of biochemical marker of myocardial necrosis together with one of the following clinical or ECG criteria: ischemic symptoms, development of pathologic Q waves, ischemic EKG changes, or a coronary intervention

24
Q

AHA/ACC claffified the clinical predictors of increased preoperative cardiovascular risk (MI, CHF, death) as major, intermediate, minor

A

Major: “active cardiac conditions” are acute MI (70years, abnormal ECG, rhythm other than sinus, uncontrolled systemic HTN,

*Aortic and Peripheral vascular surgery are placed in the High-risk surgery category with an estimated cardiac risk (MI or cardiac related death) exceeding 5%.
CEA/EVAR are regarded as intermediate risk category

25
Q

Preoperative Coronary Revascularization: CARP trial

A

randomized pts with coronary disease (except Left Main stem disease or EF80% of pts on beta blockers, >70% on ASA and >50% statins they could find no benefit to coronary revascularization. Thus preoperative coronary revascularization surgical or interventional may be of no value in preventing cardiac events except in those pts in whom revascularizations is independently indicated for acute coronary syndrome. High risk pts should have surveillance or Myocardial ischemia (troponin I or T) and risk reducing strategies (including HR control).

26
Q

Should coronary revascularization be required before vascular surgery then surgical revascularization is a suitable option compared with PCI. The safe time interval between surgical revascularization and vascular surgery is _ wks for surgical coronary revascularization and _ wks for coronary angioplasty

A

4-6 wks for surgical coronary revascularization and 2 wks for coronary angioplasty.

27
Q

The DECREASE trials evaluated the value of preoperative testing before major vascular surgery.

A

..

28
Q

Heparin induced thrombocytompenia and thrombosis can occur (immunogloblin g mediated after several days of exposure to heparin. What is the treatment?

A

cessation of all heparin, full anticoagulation with a direct thrombin inhibitor {direct thrombin inhibitors are a class of medication that act as anticoagulants by directly inhibiting the enzyme thrombin-Argatroban, Bivalirudin, Lepirudin} and 3 wks of warfarin therapy to prevent arterial thrombosis.

29
Q

IRI (ischemia reperfusion injury) is an active biphasic process (ischemia and reperfusion) in which both process contribute to injury

A

…

30
Q

Several intraoperative factors including ____ can predict postoperative kidney injury.

A

hemodynamic instability, the need for inotropic support, and the transfusion of greater than fiver units of packet cells or autologous blood can predict postoperative kidney injury

31
Q

In aortic surgery, the level of aortic clamping is correlated with postop kidney dysfunction,
With Suprarenal cross-clamping of the aorta placing the kidneys at …

A

highest risk. With suprarenal occlusion, renal blood flow decreases by 80%. Even with infrarenal aortic clamping, renal blood flow is still reduced by 45%.

32
Q

Intraoperative urine output is not predictive of postoperative renal function.

A

..

33
Q

What does mannitol do?

A

induces osmotic diuresis, decreases epithelial and endothelial cell swelling, acts as a hydroxyl free radical scavenger and increases synthesis of prostaglandin resulting in renal vasodilation.

34
Q

DOPamine infusion of 0.5 to 2 mcg/kg body weight per minute increase renal plasma flow, sodium excretion, and GFR.

A

…

35
Q

Prevention of pulmonary complications: Abdominal surgery, surgery lasting longer than 3 hours, emergency surgery, preoperative CHF and preoperative chronic lung disease as significant risk factors for pulmonary complications.

A

..

36
Q

the most effective preventive measure is postoperative lung expansion either … or …

A

CPAP OR INCENTIVE SPIROMETRY.

37
Q

2000 ARDSNET trial = reported a mortality benefit of low tidal volumes (6-8mL/kg) in pts with ARDS.

A

..

38
Q

aortic clamp site influences the risk of postoperative pulmonary complication (suprarenal vs infrarenal 25% vs 12%)

A

…

39
Q

Vascular surgey patents are at high risk for poster operative nervous system disease including…

A

delerium, stroke, and spinal cord ischemia.

40
Q

Prevention of preoperative delirium aka “central nervous system failure”:

A

…

41
Q

The spinal cord is supplied by two posterior arteries which are …

A

Anterior spinal artery which supplies 75% of spinal cord blood flow and is the primary supply to the anterolateral cord and is fed by a series of radicular arteries arising from the aorta and collateralization is POOR.
The blood supply to the thoracolumbar cord is served from the radicular artery of Adamkiewicz. In 75% of cases, it joins th anterior spinal artery between T8-T12. and in 10% it joins between L1-L2. Much of the blood flow in the anterior spinal artery depends on the artery of Adamkiewicz.

42
Q

What is a GOTT shunt?

A

a heparin zed tube that can decompress the heart and also provide distal perfusion. It is most commonly placed proximally into the ascending aorta (the most common site) and inserted distally into the descending aorta (most commonly).

43
Q

Carotid Endarterectomy

A

Most common noninvasive test is the carotid duplex ultrasonography. Positive tests are usually followed by confirmatory angiography

44
Q

Preoperative Evaluation and Preparation for CEA: Most pts presenting for CA will be taking aspirin which should be continued throughout the preoperative period.

A

..

Vascular Anesthesia (4 decks)

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