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Bioscience > CV IV > Flashcards

CV IV Flashcards

1
Q

Pathophysiologic processes that affect arteries include what three things?

A

Pathophysiologic processes that affect arteries:***

  • -Plaque formation
  • -Thrombosis (acute tissue ischemia)
  • -Aneurysm formation (weakening of arterial wall)
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2
Q

Symptoms associated with peripheral occlusive disease

include what four things?

A

Symptoms associated with peripheral occlusive disease

Claudication, skin ulcerations, gangrene, and impotence

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3
Q

Extent of disability is influenced with development of what blood flow?

A

Extent of disability is influenced with development of collateral blood flow*** (collateral circulation will sufficiently meet tissue oxygen demands)

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4
Q

As the disease process progresses limb ischemia becomes what?

A

As the disease process progresses limb ischemia becomes symptomatic requiring therapeutic intervention

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5
Q

Treatment for peripheral occlusive disease include?

A 
Treatment for peripheral occlusive disease:
Pharmacolgic therapy
Surgical therapy:
Transluminal angioplasty
Endarterectomy
Thrombectomies
Multiple bypass procedures
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6
Q

What is the anesthetic selection for a patient with peripheral vascular disease?

A

Anesthetic selection:

  • -Anesthetic technique depends on type of surgical procedure and presence of coexisting disease
  • -Local anesthetic and IV conscious sedation
  • -Regional anesthesia (on lower extremities may decrease morbidity)
  • -General anesthesia
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7
Q

What are the postoperative consideration for a patient peripheral vascular disease?

A

Postoperative considerations:

  • -Postoperative pain management an important issue
  • –Administration of narcotics (contributes to cardiac stability)
  • –Epidural opioids and local anesthetics
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8
Q

ANESTHESIA FOR SURGERY ON THE AORTA
Surgery on the aorta presents unique challenges to anesthesia care providers
Procedure complicated by what two things?

A

ANESTHESIA FOR SURGERY ON THE AORTA
Surgery on the aorta presents unique challenges to anesthesia care providers
Procedure complicated by:
—Need to cross-clamp the aorta
—Potential for large intraoperative blood loss

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9
Q

Aortic cross-clamping: ** w/o CBP will do what to LV and comprises what distally to the point of occlusion?

A

Aortic cross-clamping: ** w/o CBP will

  • —Acutely increases LV afterload; Will cause severe HTN, myocardial ischemia, LV failure, or aortic valve regurgitation***
  • –Comprises organ perfusion distal to the point of occlusion; interruption of blood flow to the spinal cord and kidneys can produce paraplegia and renal failure
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10
Q

Most serious complication with an aortic dissection?

A

Most serious complication is aneurysm rupture*****

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11
Q

Anesthesia for aneurysms of the ascending and transverse aorta requires what?

A

Anesthesia for aneurysms of the ascending and transverse aorta requires cardiopulmonary bypass**

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12
Q

Treatment of dissecting aortic lesions:

Proximal dissections nearly always treated surgically and requires what?

A

Treatment of dissecting aortic lesions:

Proximal dissections nearly always treated surgically (require CPB)*****

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13
Q

Aortic aneurysms mostly commonly involve what part of the aorta?

A

Most commonly involve the abdominal aorta**

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14
Q

What are the etiologies for aortic aneurysms?

A

Etiologies; atherosclerosis*, medial cystic necrosis, rheumatoid arthritis, spondyloarthropathies, and trauma

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15
Q

What is the greatest danger for aortic aneurysms, the formation of what?

A

Pseudoaneurysm formation*** (intima and media are ruptured)

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16
Q

What is the normal aorta width in adults?

A

Normal aorta in adults: 2-3 cm in width***

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17
Q

Atherosclerotic process usually generalized affecting other portions of what system?

A

Atherosclerotic process usually generalized affecting other portions of the arterial system

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18
Q

Aortic trauma may result in what?

A

May result in massive hemorrhage and require immediate surgical intervention

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19
Q

Aortic trauma injury can vary from a partial tear to what?

A

Injury can vary from a partial tear to a complete aortic transection

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20
Q

Patients who undergo major vascular surgery are frequently what type of population and have varying degrees of concurrent disease

A

Patients who undergo major vascular surgery are frequently elderly and have varying degrees of concurrent disease

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21
Q

Preoperative evaluation for patients going to have major vascular surgery should have Special attention should be directed toward what three functions in the body?

A

Special attention should be directed toward cardiac, renal, and neurologic function

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22
Q

Preoperative renal dysfunction directly related to what postoperatively?

A

Preoperative renal dysfunction directly related to postoperative renal failure

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23
Q

What is mandatory for intra-operative monitoring device?

A

Direct intra-arterial blood pressure monitoring

24
Q

What intra-operative monitoring device should you have that is not really mandatory for aortic trauma?

A
  • -Pulmonary artery pressure monitoring
  • -Transesophageal echocardiography (two-dimensional)
  • -In-dwelling urinary catheter
  • –Double-lumen ETT (if needed) inserted for one-lung ventilation to expose the descending thoracic aorta
25
Q

Which artery should you use for monitor arterial blood pressure for surgery on the ascending aorta?

A

Left radial artery used to monitor arterial blood pressure

26
Q

For surgery involving the aortic arch, additional considerations focus on achieving optimal cerebral protection are?

A

Additional considerations focus on achieving optimal cerebral protection:

  • -Systemic and topical hypothermia (15°C)
  • –Thiopental infusion (used to maintain a flat ECG)
  • -Methylprednisolone or dexamethasone
  • -Mannitol
  • -Phenytoin
27
Q

For surgery involving the aortic arch, long rewarming periods contribute to what?

A

Long rewarming periods contribute to intraoperative blood loss

28
Q

For surgery involving the aortic arch, rocedures usually performed through a median sternotomy and what else?

A

Procedures usually performed through a median sternotomy with deep hypothermic circulatory arrest (following CPB)

29
Q

Aorta must be cross-clamped above and below the lesion, what happens above and below it, in terms of bp?

A

Aorta must be cross-clamped above and below the lesion:
Acute HTN develops above the clamp
Hypotension below the clamp

30
Q

With surgery involving the descending thoracic aorta, what happens during cross-clamping with the LV?

A

Sudden increase in LV afterload during cross-clamping may precipitate acute LV failure and myocardial ischemia and exacerbate pre-existing aortic regurgitation****

31
Q

With surgery involving the descending thoracic aorta, what happens to CO and LVEDP?

A

CO falls and LVEDP and volume rise

32
Q

With surgery involving the descending thoracic aorta, Hemodynamic instability following release of the aortic cross-clamp (release hypotension) due to what?

A

Hemodynamic instability following release of the aortic cross-clamp (release hypotension) due to:

  • –Abrupt decrease in afterload
  • –Bleeding
  • –Release of vasodilating acid metabolites
33
Q

What is the major complication of clamping the thoracic aorta?

A

Major complication of clamping the thoracic aorta is spinal cord ischemia and paraplegia

34
Q

What is a contributing factor to paraplegia in clamping the thoracic aorta?

A

Use of nipride to control the hypertensive response to cross-clamping implicated as a contributing factor

35
Q

What are Other protective therapeutic measures to prevent paraplegia in surgeries that involving clamping of the thoracic aorta?

A 
Other protective therapeutic measures:**
Methylprednisolone
Mild hypothermia
Mannitol
Drainage of CSF
36
Q

What monitor can you use and device can you use to help prevent paraplegia as a complication of clamping the thoracic aorta?

A
  • Monitoring somatosensory evoked potentials

- Use of temporary heparin-coated shunt or partial CPB with hypothermia

37
Q

Increased incidence of renal failure following aortic surgery associated with what three things?

A

Increased incidence of renal failure following aortic surgery associated with:

  • Emergency procedures
  • Prolonged cross-clamp periods
  • Prolonged hypotension
38
Q

What three cardiac function should you maintain with patients going through aortic surgery to prevent renal failure?

A

Maintain adequate cardiac function:

  • Preload
  • Contractility
  • Systemic perfusion pressure
39
Q

What meds can you use for patients with going through aortic surgery to reduce renal failure?

A
  • Infusion of mannitol (0.5 g/kg) prior to cross-clamping
  • Low (renal)-dose dopamine
  • Fenoldopam infusions (rapid acting vasodilators)
40
Q

What two approaches can you have with surgery on the abdominal aorta?

A

SURGERY ON THE ABDOMINAL AORTA

Anterior transperitoneal or anterolateral retroperitoneal approach

41
Q

Where can the crooss-clamp be applied to for an abdominal aorta? (three ways)

A

Cross-clamp can be applied to the supraceliac, suprarenal, or infrarenal aorta**

42
Q

What drug is necessary before occlusion before abdominal aorta?

A

Heparinization prior to occlusion is necessary

43
Q

What kinda of blood pressure monitoring do you need for surgery on the abdominal aorta?

A

Intra-arterial blood pressure monitoring

44
Q

Farther distally the clamp is applied the less effect on what part of the heart will you have?

A

Farther distally the clamp is applied, the less effect on LV afterload**

45
Q

What should the fluid replacement be guided by? and how much fluid should you be giving?

A

Fluid replacement guided by CVP or PA monitoring (10-12ml/kg)

46
Q

What drug should you use for renal prophylaxis with patients undergoing surgery on the abdominal aorta?

A

Renal prophylaxis with mannitol

47
Q

What type of anesthesia can you use in conjunction with general anesthesia with patients undergoing surgery on the abdominal aorta? (hint: its a block)

A

Epidural anesthesia (before heparin and stop heparin way after the coags are back to normal) (concerned with epidural hematoma) in conjunction with general anesthesia

48
Q

What is the initial emphasis in postoperative care that should be focused on with patients that went through abdominal aortic surgery? two things

A

Initial emphasis in postoperative care should be on maintaining hemodynamic stability and monitoring for postoperative bleeding

49
Q

With endovascular aortic aneurysm repair, what does the graft do in terms of blood flow?

A

Graft restricts blood flow to the portion of the aorta in which the aneurysm exists

50
Q

What is a less invasive approach to endovascular aortic aneurysm repair?

A

Deployment of an endovascular stent graft within the aortic lumen

Performed for descending thoracic aortic aneurysms or abdominal aortic aneurysms

51
Q

What should your anesthesia appoarch be with a patient undergoing endovascular AAA repair?

A

Administration of anesthesia:
Endovascular AAA repair:
Neuraxial blockade or local anesthesia and sedation

52
Q

What should your anesthesia appoarch be for a patient undergoing endovascular thoracic aortic aneurysm repair?

A

Administration of anesthesia:
Endovascular thoracic aortic aneurysm repair:
General anesthesia

53
Q

For anesthesia with carotid artery surgery, what does ischemic strokes usually result from?

A

Ischemic strokes are usually the result of thrombosis or embolism in one of the blood vessels supplying the brain

54
Q

With patients under going carotid artery surgery what symptom should be stable and well controlled??

A

Angina should be stable and well controlled

55
Q

What two clinical status (disease process) should be optimized for someone undergoing carotid artery surgery?

A

Optimize clinical status in terms of co-existing diseases

  • –Uncontrolled preoperative HTN** (can cause more issues post op if uncontrolled)
  • –Uncontrolled hyperglycemia*** (want to control this, if not controlled, it will increase cerebral ischemic injury)
56
Q

Where should your MAP before for patients undergoing carotid artery surgery?

A

MAP maintained at or slightly above usual range***

Bioscience (9 decks)

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