Cardiovascular Surgical Procedures Flashcards
bronchoscopy: definition
-direct visualization mucosa of trachea, upper bronchi in to treat/DX pulmonary symptoms by means of flexbile/rigid endosdcope
rigid bronchoscopy
- instrument of choice for removal of foreign bodies*
- large diameter, rigid, metal, speculum
flexible bronchoscopy
narrow diameter flexible endoscope
flexible tipped aspirations tubes used to collect secretions via bronchoscopy are called
Lukens or Clerf Tubes
bronchoscopy wound class
wound class 2
mediastinoscopy: definiton
visualization/biopsy lymph nodes & tumors within upper & anterior mediastinal cavities by means of rigid lighted speculum (mediastinocope) for DX of neoplasms
mediastinotomy (Chamberlain Procedure): definition & incision
- alternative to mediastinoscopy for PTs with neck immobility
- incison: through costal cartilage of left hemithorax (mini-thoracotomy)
mediastinoscopy: pathophysiology
aid in DX staging of lung neoplasms
lung neoplasm
- group of bronchogenic malignancies from lung epithelium
- small & large cell carcinomas
mediastinoscopy: major complications
super, massive, hemorrhage
mediastinoscopy: incision
2cm transverse incision superior to suprasternal notch
thoracoscopy: defintion
direct visualization of lungs/pleural cavity by means of rigid lighted endoscope (thoracoscope)
thoracoscopy: wedge resection
most conservative treatment
removal of small wedge of peripheral lung tissue
thoracoscopy: segementectomy segmental resection)
removal of one or more bronchopulmonary segments
thoracoscopy: lobectomy
removal of one or more lung lobes
thoracoscopy: pneumonectomy
genreally not performed thorascopically
removal of entire lung
thoracoscopy: lung volume reduction
removal of diseased lung parenchyma for treatment of emphysema
thoracoscopy: talc pleurodesis (poudrage)
- production of adhesions between parietal & visceral pleura via intimation of talc powder*
- pneumothorax, empyema, effusion
thoracoscopy: special consideration
use of double lumen endotracheal tube allows collapse of affected lung with simultaneous ventilation of contralateral
thoracoscopy: post operative lung reexpansion entails use of what?
chest tube & pleur-evac system (closed water seal drainage system)
thoracotomy: definiton
incision into chest wall in order to expose lungs (thoracic viscera) to allow surgical treatment of benign and malignant conditions
thoracotomy: thymectomy
- removal of enlarged thymus gland*
- treats neoplasms of thymus gland & autoimmune disorders
thoracotomy: pulmonary decortication
excision into any fibrous restrictive membrane of parietal or visceral pleura interfering with pulmonary ventilation to restore normal lung function
thoracotomy: empyema
- infectious pus-rich fluid between pleura causing dyspnea*
- often result of pneumonia
- dyspnea fibrous adhesions
thoracotomy: incisions (4)
- anterolateral
- posterolateral
- median sternotomy
- thoracoabdominal
thoracotomy incision: posterolateral
most common for lung exposure
thoracotomy incision: median sternotomy
incision of choice for cardiac procedures
thoracotomy: anesthesia special considerations
use of double lumen endotracheal tube allows collapse of affected lung with simultaneous ventilation of non-operative lung
cardio-pulmonary bypass (CPB): what solution is infused to the heart to make it rapidly arrest?
cold potassium cardioplegia solution rapidly arrests the heart
-inhibits myocardial contractions
cardio-pulmonary bypass (CPB): benefits of induced hypothermia on arrested heart?
- prevents tissue damage due to ischemia*
- cold saline slush is placed around heart
coronary artery bypass grafting (CABG): definition
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
coronary artery bypass grafting (CABG): 3 arteries bypassed
- left anterior descending (50%)
- right main coronary artery (30-40%)
- circumflex artery (15-20%)
coronary artery bypass grafting (CABG): primary conduits used to achieve bypass (4)
- internal mammary artery
- greater saphenous vein
- radial artery
- gastroepiploic artery
coronary artery bypass grafting (CABG): pathophysiology
- ischemia; atherosclerosis*
- initial ischemia produces symptoms of angina pectoris; tight squeezing substernal pain
coronary artery bypass grafting (CABG): incision
median sternotomy
abdominal aortic aneurysmectom (AAA): definition
surgical obliteration of abnormal violation of abdominal aorta w/ subsequent placement of prosthesis to reestablish vascular continuity
AAA: are symptomatic until rupture, often diagnosed made accidentally True or False
True
AAA: where are AAAs most likely to occur?
- below renal arteries and above aortic bifurcation
- may involve renal arteries and extend to iliac arteries
AAA: do ruptured AAAs constitute surgical emergency?
symptoms include pulsating abdominal mass
Yes
AAA types of aneurisms: fusiform
- true aneurism*
- circumferential dilation of vessel wall (football shaped)
- most common aortic aneurism
AAA types of aneurisms: saccular
- true aneurism*
- outpouching from weakness on one side of vessel wall
- most common cranial
AAA types of aneurisms: dissecting
blood infiltrates vessel wall separating layers
AAA types of aneurisms: pseudo aneurysm
- false aneurism*
- tear through all layers of vessel wall escaping blood contained by perivascular
AAA: what is administered by anesthesia to prevent thromboembolism
heparin is administered intravenously
AAA: agent used to reverse heparin
protamine sulfate
AAA: suture used for vessel anastomoses?
double armed prolene suture (monofilament)
AAA definition/use: pledgets
- small pieces of teflon used during cardiovascular surgery used to seal leaking anastomoses*
- loaded on vascular suture
AAA: pre clotting
- makes graft impervious to blood
- achieved by submerging graft in basin of PTs blood (obtained prior to heparinization)
AAA: vascular prosthesis grafts (3)
- knitted polyester ONLY PRECLOT
- knitted velour
- woven polyester
AAA: retractors used to achieve wide exposure/retraction of viscera
omni-trac
backwalter
AAA: incision
vertical midline incision
xiphoid process to symphysis pubis
angioplasty: definition
recanalization of occluded vessel through the use of intravascular catheter balloons to treat atherosclerotic lesions via vessel dilation
angioplasty: function of balloon catheter
inflated into stenotic lesion & inflated compressing plaque against vessel wall and dilating lumen
angioplasty: nitroglycerin should be available in case of?
vasospasm; coronary angioplasty
nitroglycerin should be available for intra-operative administration
angioscopy: definition
direct visualization of the lumen of a vessel by means of fiberoptic endoscope (angioscope) to DX conditions, interrupt venous tributaries or disrupt venous valves
arteriovenous (AV) shunt/fistula: definiton
creation of direct connection between artery and vein establishing access point for patients undergoing long term renal dialysis & HEMODIALYSIS
arteriovenous (AV) shunt/fistula: commonly used vessels
- radial artery to cephalic vein*
- Brescia-Cimino fistula in wrist; longest potency lowest infection rates
arteriovenous (AV) shunt/fistula: complications (2)
- infection/hemorrhage
- thromboembolism
femoropopliteal bypass: definition
prevent progressive ischemia of distal appendage
restoration of blood flow to the leg via placement of conduit that bypasses occluded segment of femoral artery
femoropopliteal bypass: pathophysiology
-intermittent claudication (functional ischemia) rest pain (critical ischemia)
femoropopliteal bypass: synthetic prosthesis
gore-tex used
requires tunneler
greatest success above the knee procedures
femoropopliteal bypass: reversed autologous vein grafts
requires tunneler
criterion standard for inguinal bypass procedure with great success procedures above and below knee
femoropopliteal bypass: in situ autologous vein graft
requires use of valvulotome
femorofemoral bypass: definition (2)
- restoration of blood flow to 1 leg
- bypasses occluded common iliac artery
axillobifemoral bypass: definition
- restoration of blood flow to both legs
- bypasses bilateral occluded common iliac arteries
femoropopliteal bypass: retractors used for exposure (3)
- gelpi
- weitlaner
- garret
carotid endarterectomy: definition
surgical removal of atheroma at carotid artery bifurcation to decrease likely hood of embolization and subsequent stroke
carotid endarterectomy: circle of willis and tributaries
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
carotid endarterectomy: internal carotid arteries furnish blood to…
circle of willis ANTERIORLY
carotid endarterectomy: vertebral arteries furnish blood to…
circle of willis POSTERIORLY
carotid endarterectomy: hallmarks of carotid artery disease
transient ischemic attacks (TIAs)
-episodes of temporary neurologic impairment that resolve in 24-48 hours
carotid endarterectomy: cervical plexus block (2)
- regional anesthesia
- CONSCIOUS PT is observed for sudden neurologic deficits
carotid endarterectomy: electroencephalography (EEG)
- general anesthesia
- UNCONCIOUS PT cerebral activity monitored
carotid endarterectomy: shunts used when cerebral profusion is decreased?
Argyle or Javid shunt
carotid endarterectomy: vessel loops/umbilical tape are passed with what when being used to isolate/idenitfy vessel?
right angle clamp
arrteriotomy: blade # handle # & is extended with?
#11 blade #7 handle *extended with Potts-Smith angulated scissors
carotid endarterectomy: PT positon
- neck may be extended with placement of scapular roll*
- supine
embolectomy/thrombectomy: definition
removal of solid mass from vessel that is occluding circulation
embolectomy/thrombectomy:
thrombus
embolus
embolism
- thrombus: clot adhered to wall
- embolus: mass carried within blood stream
- embolism: sudden obstruction of blood vessel (embolus reaches destination and stops)
embolectomy/thrombectomy: the 6 Ps
- pain
- pulselessness
- paresthesia
- paralysis
- pallor
- poikilothermia
embolectomy/thrombectomy: thrombolytic therapy medications
stimulate enzymatic liquefaction of fibrin
- streptokinase
- urokinase
- tissue-type plasminogen activator (t-pa)
- heparin (not used for thrombolysis)
embolectomy/thrombectomy: surgical removal of a clot is achieved with use of?
Fogarty balloon catheter
Vena Cava Device Insertion: vena cava filters (VCF)
Greenfield device most common
trap emboli origination from DVT in lower extremities, preventing pulmonary embolism
Saphenous Vein Ligation and Stripping: stripping
- removal of long segment of disease vein via vein stripper*
- long cordlike device with acorn tip dissector
Saphenous Vein Ligation and Stripping: pathophysiology
varicose veins of lower extremity
Venous Access Device Insertion: common routes of insertion (2)
- right internal or external jugular
- subclavian veins
Venous Access Device Insertion: intraoperative fluoroscopy is used…
to ensure proper guidance/placement of catheter
Venous Access Device Insertion: position
supine in slight trendelenberg (dilates neck veins) with head turned to left side
