CV - OPCABG

Question 1

CPB without use of aortic cross clamp or cardiac arrest

Answer 1

Beating heart CPB

Question 2

CABG on CPB

Answer 2

On-pump CABG

Question 3

Thoracotomy approach (usually for single vessel LIMA to LAD bypass)

Answer 3

MIDCAB

Question 4

Davinci robot for minimally invase heart surgery

Answer 4

Robotic Heart Surgery

Question 5

Coronary oxygen extraction

Answer 5

The highest at 65-75%

Question 6

V02

Answer 6

oxygen consumption

Question 7

MV02

Answer 7

Myocardial oxygen consumption

Question 8

SV02

Answer 8

Venous oxygen saturation (mixed venous oxygen)

Question 9

Ca02 =

Answer 9

1.31 x Hgb x Sa02 + 0.003(Pa02)

Question 10

CPP =

Answer 10

AoDBP - LVEDP

Question 11

Preload =

Answer 11

LVEDV (SV)

Question 12

HR =

Answer 12

diastolic filling time

Question 13

Review slide 11

Answer 13

Frank-starling curve

Question 14

Anesthetic Management of OPCAB

Answer 14

GETA with or without thoracic epidural, Monitors (Art line, CVP, PAC, TEE, Cerebral Ox, 5 Lead EKG, Standard ASA monitors), Warming device, IVF with fluid warmer, low dose heparin, antifibrinolytics, narcotics, CPB on backup

Question 15

For OPCAB, maintain NSR with HR ____ to _____

Answer 15

60 to 80

Question 16

Want to increase Preload to maintain filling, maximize starling curve, and avoid excessive _______/_______

Answer 16

LVEDV/Wall Stress

Question 17

Want to maintain what during OPCAB

Answer 17

high hgb, Sa02, Pa02, AoDBP, CO (SV, CBF)

Question 18

Want to mnimize sympathetic stimulation by managing….

Answer 18

pain, inotropy, chronotropy

Question 19

Provide coronary dilation and ______ preconditioning

Answer 19

ischemic

Question 20

Most important he said is to provide excellennt ________

Answer 20

communication

Question 21

Where will grafts be harvested from?

Answer 21

LIMA, LSVG, LRAd, RIMA

Question 22

What order are anastamosiis usually completed?

Answer 22

Proximal first then Distal next (due to shunting)

Question 23

Risks associated with CPB

Answer 23

coagulopathy, neurologic deficit, air/plaque embolism, Aortic manipulation, ventricular arrest, defibrillation, pacing, difficulty of separation from CPB, transfusion of PRBC, FFP, PLT, Cryo, cannulation site trauma and bleeding, risk of recall, risk of full dose heparin and protamine, risk of deep hypothermia <34 , risk of hemodilution and volume shifts,

Question 24

Benefits of OPCAB

Answer 24

Avoidance of the risks and it’s potentially a faster surgery, decreased cost to patient, decreased ICU and hosptial stay, decreased duration of intubation, decreased requirement for intotropic, chronotropic, or vasocative support, potentially decreased risk of infection and improved wound healing, potentially faster recovery

Question 25

Risks of OPCABG surgery

Answer 25

Direct trauma to myocardium, unprotected myocardium with occlusion of coronary targetrs, decreased cardiac function intra-op, decreased cardiac output / organ perfusion / systemic pressure, increased requirement for drips intra-op, decreased graft patency due to technical difficulty or thrombosis, more work for the anesthesiologist

Question 26

Read the guide

Answer 26

Cardiac Anesthesia made ridiculously simple as asupplement to this lecture

Question 27

Without the use of assistive devices such as CPB, Left heart bypass, Ventricular assist device

Answer 27

Off-pump