Cardiovascular anesthesia Flashcards
Denise
retrograde autologus priming uses
pt blood to displace crystalloid primed pump tubing
when full flow on pump is confirmed, you should
turn vent to bag and monitor to bypass mode. Sevo off
Most difficult crawford aneurysms to remair
1 and 2
Crawford 2 aneurysm has significant risk for
paraplegia and renal failure
artery of adamkiewicz
Which dissection is a surgical emergency
acute dissection of ascending aorta
often includes aortic valve
which dissection is usually medically manaanged
descending aorta (unless ruptured or leaking)
Classic AAA triad
- hypotension
- back pain
- Pulsatile abdominal mass
higher clamp generally means
greater insult
how many posterior spinal arteries are there and what is perfused
2 posterior spinal arteries perfuse posterior 1/3 of the spinal cord
How many anterior spinal arteries are there and what is perfuse
1 anterior spinal artery
perfuses anterior 2/3 of spinal cord
Most important of paired radicular arteries
artery of adamkiewcz
What does the artery of adamkiewicz perfuse and where does it originate
anterior cord in thorocolumabr region
usually originates on left between T11 and T12
watershed areas
regions of spinal cord that have single blood supply
particularly vulnerable to ischemia
Which region of cord is highly dependent on artery supply and result
Thoracolumbar region of anterior spinal cord
interruption of radicular flow can cause ischemia/infarction
Cross clamping avove artery of adamkiewicz can cause
anterior spinal syndrom
s/sx anterior spinal syndrome
aka beck’s syndrome
1. flaccid paralysis of lowers
2. bowel/bladder dyfuction
3. loss temp and pain sensation
touch and proprioception is preserved!
corticospinal tract is perfused by
anterior blood supply
(flaccid paralysis)
Autonomic motor fibers are perfused by
anterior blood supply
(bowel/bladder)
Spinothalmic perfushed by
anterior blood supply
loss of temp/pain sensation
Dorsal column perfused by
posterior blood supply
touch/propreoception preserved
Perfused by anterior blood supply (3)
and what is each responsible for?
- corticospinal tract (r/t flaccid paralysis)
- autonomic motor fibers (r/t bowel/bladder)
- spinothalmic (r/t loss of temp/pain sensation)
perfused by posterior blood supply
Dorsal column (touch/proprioception)
Amaurosis Fugax
blindness in one eye
sign of impending stroke
emboli from ICA to opthalmic artery
Best neuro monitoring
an awake patient
CPP =
MAP - ICP (or CVP, whichever is higher)
What increases EEG frequency
- mild hypercarbia
- early hypoxemia
- seizure
- ketamine
- N2O
- light anesthesia
What decreases EEG frequency
- very hypercarbic
- hypoxic
- cerebral ischemia
- hypothermia
- OD of anesthetic
- opioids
carotid stump pressure that indicates possible cerebral hypoperfucsion
<50 mmHg
carotid stump measurement is taken distal to clamp
Surgical stimulation of carotid endardectomy can activate
baroreceptor relfex
baroreceptor relfex management
- glycopyrrolate (possibly pre medicate)
- ask surgeon to stop
- infiltrate carotid body with local anesthetic
Hypercarbia can create a (carotid endardectomy)
steal phenomenon and shunt blood away from hypoperfused cerebral tissue
Carotid endardectomy hematoma considerations
can cause compromised airway
may not see it at site but can cause tracheal deviation
may need trach
balloon inflation in carotid artery stenting
Balloon inflation–>baroreceptors–>bradycardia–>hypotension
pretreat with glycopyrrolate or atropine
most common complication of carotid artery stenting
thromboembolic stroke d/t debris
TransCarotid Artery Revascularization
blood flow is reversed in area of blockage
reducesrisk of stroke during balloon inflation
reversal of blood flow in TCAR reduces risk of
stroke during balloon inflation
clot gets caught in machine
