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Surgical Procedures 1 > Cardiovascular Surgical Procedures > Flashcards

Cardiovascular Surgical Procedures Flashcards

1
Q

bronchoscopy: definition

A

-direct visualization mucosa of trachea, upper bronchi in to treat/DX pulmonary symptoms by means of flexbile/rigid endosdcope

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2
Q

rigid bronchoscopy

A
  • instrument of choice for removal of foreign bodies*

- large diameter, rigid, metal, speculum

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3
Q

flexible bronchoscopy

A

narrow diameter flexible endoscope

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4
Q

flexible tipped aspirations tubes used to collect secretions via bronchoscopy are called

A

Lukens or Clerf Tubes

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5
Q

bronchoscopy wound class

A

wound class 2

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6
Q

mediastinoscopy: definiton

A

visualization/biopsy lymph nodes & tumors within upper & anterior mediastinal cavities by means of rigid lighted speculum (mediastinocope) for DX of neoplasms

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7
Q

mediastinotomy (Chamberlain Procedure): definition & incision

A
  • alternative to mediastinoscopy for PTs with neck immobility
  • incison: through costal cartilage of left hemithorax (mini-thoracotomy)
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8
Q

mediastinoscopy: pathophysiology

A

aid in DX staging of lung neoplasms

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9
Q

lung neoplasm

A
  • group of bronchogenic malignancies from lung epithelium

- small & large cell carcinomas

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10
Q

mediastinoscopy: major complications

A

super, massive, hemorrhage

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11
Q

mediastinoscopy: incision

A

2cm transverse incision superior to suprasternal notch

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12
Q

thoracoscopy: defintion

A

direct visualization of lungs/pleural cavity by means of rigid lighted endoscope (thoracoscope)

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13
Q

thoracoscopy: wedge resection

A

most conservative treatment

removal of small wedge of peripheral lung tissue

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14
Q

thoracoscopy: segementectomy segmental resection)

A

removal of one or more bronchopulmonary segments

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15
Q

thoracoscopy: lobectomy

A

removal of one or more lung lobes

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16
Q

thoracoscopy: pneumonectomy

A

genreally not performed thorascopically

removal of entire lung

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17
Q

thoracoscopy: lung volume reduction

A

removal of diseased lung parenchyma for treatment of emphysema

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18
Q

thoracoscopy: talc pleurodesis (poudrage)

A
  • production of adhesions between parietal & visceral pleura via intimation of talc powder*
  • pneumothorax, empyema, effusion
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19
Q

thoracoscopy: special consideration

A

use of double lumen endotracheal tube allows collapse of affected lung with simultaneous ventilation of contralateral

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20
Q

thoracoscopy: post operative lung reexpansion entails use of what?

A

chest tube & pleur-evac system (closed water seal drainage system)

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21
Q

thoracotomy: definiton

A

incision into chest wall in order to expose lungs (thoracic viscera) to allow surgical treatment of benign and malignant conditions

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22
Q

thoracotomy: thymectomy

A
  • removal of enlarged thymus gland*

- treats neoplasms of thymus gland & autoimmune disorders

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23
Q

thoracotomy: pulmonary decortication

A

excision into any fibrous restrictive membrane of parietal or visceral pleura interfering with pulmonary ventilation to restore normal lung function

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24
Q

thoracotomy: empyema

A
  • infectious pus-rich fluid between pleura causing dyspnea*
  • often result of pneumonia
  • dyspnea fibrous adhesions
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25
Q

thoracotomy: incisions (4)

A
  • anterolateral
  • posterolateral
  • median sternotomy
  • thoracoabdominal
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26
Q

thoracotomy incision: posterolateral

A

most common for lung exposure

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27
Q

thoracotomy incision: median sternotomy

A

incision of choice for cardiac procedures

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28
Q

thoracotomy: anesthesia special considerations

A

use of double lumen endotracheal tube allows collapse of affected lung with simultaneous ventilation of non-operative lung

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29
Q

cardio-pulmonary bypass (CPB): what solution is infused to the heart to make it rapidly arrest?

A

cold potassium cardioplegia solution rapidly arrests the heart
-inhibits myocardial contractions

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30
Q

cardio-pulmonary bypass (CPB): benefits of induced hypothermia on arrested heart?

A
  • prevents tissue damage due to ischemia*

- cold saline slush is placed around heart

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31
Q

coronary artery bypass grafting (CABG): definition

A

re-vasculareization of myocardium by means of bypassing occluded segments of coronary circulation with autologous vessels, alleviating angina pectoris and prolonging life in PTs with coronary artery disease

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32
Q

coronary artery bypass grafting (CABG): 3 arteries bypassed

A
  • left anterior descending (50%)
  • right main coronary artery (30-40%)
  • circumflex artery (15-20%)
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33
Q

coronary artery bypass grafting (CABG): primary conduits used to achieve bypass (4)

A
  • internal mammary artery
  • greater saphenous vein
  • radial artery
  • gastroepiploic artery
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34
Q

coronary artery bypass grafting (CABG): pathophysiology

A
  • ischemia; atherosclerosis*

- initial ischemia produces symptoms of angina pectoris; tight squeezing substernal pain

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35
Q

coronary artery bypass grafting (CABG): incision

A

median sternotomy

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36
Q

abdominal aortic aneurysmectom (AAA): definition

A

surgical obliteration of abnormal violation of abdominal aorta w/ subsequent placement of prosthesis to reestablish vascular continuity

37
Q

AAA: are symptomatic until rupture, often diagnosed made accidentally True or False

A

True

38
Q

AAA: where are AAAs most likely to occur?

A
  • below renal arteries and above aortic bifurcation

- may involve renal arteries and extend to iliac arteries

39
Q

AAA: do ruptured AAAs constitute surgical emergency?

A

symptoms include pulsating abdominal mass

Yes

40
Q

AAA types of aneurisms: fusiform

A
  • true aneurism*
  • circumferential dilation of vessel wall (football shaped)
  • most common aortic aneurism
41
Q

AAA types of aneurisms: saccular

A
  • true aneurism*
  • outpouching from weakness on one side of vessel wall
  • most common cranial
42
Q

AAA types of aneurisms: dissecting

A

blood infiltrates vessel wall separating layers

43
Q

AAA types of aneurisms: pseudo aneurysm

A
  • false aneurism*

- tear through all layers of vessel wall escaping blood contained by perivascular

44
Q

AAA: what is administered by anesthesia to prevent thromboembolism

A

heparin is administered intravenously

45
Q

AAA: agent used to reverse heparin

A

protamine sulfate

46
Q

AAA: suture used for vessel anastomoses?

A

double armed prolene suture (monofilament)

47
Q

AAA definition/use: pledgets

A
  • small pieces of teflon used during cardiovascular surgery used to seal leaking anastomoses*
  • loaded on vascular suture
48
Q

AAA: pre clotting

A
  • makes graft impervious to blood

- achieved by submerging graft in basin of PTs blood (obtained prior to heparinization)

49
Q

AAA: vascular prosthesis grafts (3)

A
  • knitted polyester ONLY PRECLOT
  • knitted velour
  • woven polyester
50
Q

AAA: retractors used to achieve wide exposure/retraction of viscera

A

omni-trac

backwalter

51
Q

AAA: incision

A

vertical midline incision

xiphoid process to symphysis pubis

52
Q

angioplasty: definition

A

recanalization of occluded vessel through the use of intravascular catheter balloons to treat atherosclerotic lesions via vessel dilation

53
Q

angioplasty: function of balloon catheter

A

inflated into stenotic lesion & inflated compressing plaque against vessel wall and dilating lumen

54
Q

angioplasty: nitroglycerin should be available in case of?

A

vasospasm; coronary angioplasty

nitroglycerin should be available for intra-operative administration

55
Q

angioscopy: definition

A

direct visualization of the lumen of a vessel by means of fiberoptic endoscope (angioscope) to DX conditions, interrupt venous tributaries or disrupt venous valves

56
Q

arteriovenous (AV) shunt/fistula: definiton

A

creation of direct connection between artery and vein establishing access point for patients undergoing long term renal dialysis & HEMODIALYSIS

57
Q

arteriovenous (AV) shunt/fistula: commonly used vessels

A
  • radial artery to cephalic vein*

- Brescia-Cimino fistula in wrist; longest potency lowest infection rates

58
Q

arteriovenous (AV) shunt/fistula: complications (2)

A
  • infection/hemorrhage

- thromboembolism

59
Q

femoropopliteal bypass: definition

A

prevent progressive ischemia of distal appendage

restoration of blood flow to the leg via placement of conduit that bypasses occluded segment of femoral artery

60
Q

femoropopliteal bypass: pathophysiology

A 
-intermittent claudication (functional ischemia)
rest pain (critical ischemia)
61
Q

femoropopliteal bypass: synthetic prosthesis

A

gore-tex used
requires tunneler
greatest success above the knee procedures

62
Q

femoropopliteal bypass: reversed autologous vein grafts

A

requires tunneler

criterion standard for inguinal bypass procedure with great success procedures above and below knee

63
Q

femoropopliteal bypass: in situ autologous vein graft

A

requires use of valvulotome

64
Q

femorofemoral bypass: definition (2)

A
  • restoration of blood flow to 1 leg

- bypasses occluded common iliac artery

65
Q

axillobifemoral bypass: definition

A
  • restoration of blood flow to both legs

- bypasses bilateral occluded common iliac arteries

66
Q

femoropopliteal bypass: retractors used for exposure (3)

A
  • gelpi
  • weitlaner
  • garret
67
Q

carotid endarterectomy: definition

A

surgical removal of atheroma at carotid artery bifurcation to decrease likely hood of embolization and subsequent stroke

68
Q

carotid endarterectomy: circle of willis and tributaries

A

circular anastomosis of arteries at the base of the cranial cavity which equitably distributes blood to the brain ensuring continuity of flow in event of occlusion

69
Q

carotid endarterectomy: internal carotid arteries furnish blood to…

A

circle of willis ANTERIORLY

70
Q

carotid endarterectomy: vertebral arteries furnish blood to…

A

circle of willis POSTERIORLY

71
Q

carotid endarterectomy: hallmarks of carotid artery disease

A

transient ischemic attacks (TIAs)

-episodes of temporary neurologic impairment that resolve in 24-48 hours

72
Q

carotid endarterectomy: cervical plexus block (2)

A
  • regional anesthesia

- CONSCIOUS PT is observed for sudden neurologic deficits

73
Q

carotid endarterectomy: electroencephalography (EEG)

A
  • general anesthesia

- UNCONCIOUS PT cerebral activity monitored

74
Q

carotid endarterectomy: shunts used when cerebral profusion is decreased?

A

Argyle or Javid shunt

75
Q

carotid endarterectomy: vessel loops/umbilical tape are passed with what when being used to isolate/idenitfy vessel?

A

right angle clamp

76
Q

arrteriotomy: blade # handle # & is extended with?

A 
#11 blade
#7 handle 
*extended with Potts-Smith angulated scissors
77
Q

carotid endarterectomy: PT positon

A
  • neck may be extended with placement of scapular roll*

- supine

78
Q

embolectomy/thrombectomy: definition

A

removal of solid mass from vessel that is occluding circulation

79
Q

embolectomy/thrombectomy:
thrombus
embolus
embolism

A
  • thrombus: clot adhered to wall
  • embolus: mass carried within blood stream
  • embolism: sudden obstruction of blood vessel (embolus reaches destination and stops)
80
Q

embolectomy/thrombectomy: the 6 Ps

A
  • pain
  • pulselessness
  • paresthesia
  • paralysis
  • pallor
  • poikilothermia
81
Q

embolectomy/thrombectomy: thrombolytic therapy medications

A

stimulate enzymatic liquefaction of fibrin

  • streptokinase
  • urokinase
  • tissue-type plasminogen activator (t-pa)
  • heparin (not used for thrombolysis)
82
Q

embolectomy/thrombectomy: surgical removal of a clot is achieved with use of?

A

Fogarty balloon catheter

83
Q

Vena Cava Device Insertion: vena cava filters (VCF)

A

Greenfield device most common

trap emboli origination from DVT in lower extremities, preventing pulmonary embolism

84
Q

Saphenous Vein Ligation and Stripping: stripping

A
  • removal of long segment of disease vein via vein stripper*

- long cordlike device with acorn tip dissector

85
Q

Saphenous Vein Ligation and Stripping: pathophysiology

A

varicose veins of lower extremity

86
Q

Venous Access Device Insertion: common routes of insertion (2)

A
  • right internal or external jugular

- subclavian veins

87
Q

Venous Access Device Insertion: intraoperative fluoroscopy is used…

A

to ensure proper guidance/placement of catheter

88
Q

Venous Access Device Insertion: position

A

supine in slight trendelenberg (dilates neck veins) with head turned to left side

Surgical Procedures 1 (12 decks)

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