Exam 1 Highlighted Material

Question 1

B Blockers in Vascular Surgery.
When Should they be started?
Target HR?

Answer 1

Started >1 day (Days-weeks before)
Target HR 50-60

Question 2

When should a statin be started on a vascular surgery patient?

Answer 2

30 days

Question 3

What is the #1 compliucation in vascular surgery?

Answer 3

MI not Stroke. Stroke is number 2

Question 4

3 biggest RF in vascular surgery

Answer 4

DM, Tobacco and Hyperlipdemia

Question 5

Indications for CEA

Answer 5

–TIAs associated with ipsilateral severe carotid stenosis (>70%)
–Severe Ipsilateral stenosis in patient with incomplete stroke
–30-70% occlusion in a patient with ipsilateral symptoms

Question 6

What is luxury perfusion?

Answer 6

These blood vessels are maximally vasodilated
resulting in maximal blood flow to the area & changes
in PaCO2 have no effect on is local blood flow when
normocapnia is present

Question 7

What is cerebral steal syndrome?

Answer 7

A PaCO2 increase results in vasodilation of normal
blood vessels that will shunt blood away from the
diseased area – hypercapnia

Question 8

What is the robin hood effect

Answer 8

During times of low PaCO2 vasoconstriction occurs but the diseased vessls stay dialated robbing the healthy tissue of CBF

Question 9

Pitfalls of Shints during CEA

Answer 9

1. Trauma to the vessel
2. Embolism– Air or thrombus formation

Question 10

What is the BP goal during cross clamping during CEA?

Answer 10

20 % ↑ in BP for colateral perfusion

Question 11

During CEA what causes sudden hypotension and bradycardia ? how can this be avoided? What Complication can happen from this treatment?

Answer 11

Manipulation of the carotid bodies resulting in a baro receptro reflex

Treated with 1 % lidocain applied to the carotid bifurcation

This can result in post op hypertension

Question 12

Risk factors for AAA

Answer 12

Male >female
50-80 yo
Smoker
Family history
HTN, HLD, CAD, PVD
COPD
Caucasion

Question 13

Contraindications for elective AAA repair

Answer 13

Recent MI
Chronic Renal Insufficiency
Severe Pulmonary dysfunction
intractable Pectoralis Angina

Question 14

Law of Laplace equation

Answer 14

T (Wall Tension) = R (Radius of vessel) x P (Transmural Pressure)

Question 15

Respiratory Preop preparation for AAA

Answer 15

Smoking Cessation,
Bronchodilators
IS
Chest PT
↓ Risk of Postop complications

Question 16

CV Preop for AAA

Answer 16

Hx of CAD? probably
Check BP in both arms use the higher for A line
HTN ↑ risk of rupture; Tight BP control

Question 17

Renal Prop AAA

Answer 17

Renal insufficiency is common in these patients secondary to HTN DM and atherosclerosis repurfusion

Usually dry d/t radiology studies and bowel prep

Question 18

Heme Prop AAA

Answer 18

ASA if patient has CAD and DAPT should be bridged to shorter half life before procedure
Alcoholic have anemia
Coags, TC, and 6u PRBC ready
DVT prophylaxis

Question 19

Anesthesia Goals for AAA

Answer 19

Keep them warm
Keep HR slow
Avoid Anemai
Prevent HTN

Question 20

Response to Aortic cross clamping is directly related to …

Answer 20

Placement of clamp (usually infrarenal
Volume status
Cardiac reserve

Question 21

Application of Aortic clamp causes

Answer 21

Central Hypervolemia
shunting blood proximal to clamp causing ↑ in venous return

Question 22

Release of Clamp causes

Answer 22

Central hypovolemia

Capillary beds leak d/t rush of blood to the LE causing ↓ in venous return

Question 23

_______ above the clamp and _____ below the calmp

Answer 23

____HTN___ above the clamp and __Hypotension___ below the calmp

Question 24

Aortic Cross Clamping Hemodynamics,

↑ in … (7)

Answer 24

1. Arterial Wall motion above clamp
   2.Segmental Wall Abnormalities
   3, Ventricular Wall motion (contractility)
2. PAOP
3. PAP
4. Coronary BF
5. Myocardial O2 Demand

Question 25

Aortic Cross Clamping Hemodynamics, ↓ in... (4)

Answer 25

1. Renal Bloof Flow 2. Blood Pression Below Clamp 3. EF 4. CO

Question 26

Metabolic changes after Aortic Cross Clamp ↑ in ... (3)

Answer 26

1. Resp Alkilosis and Metabolic Acidosis 2. Mixed Venous O2 3. Epi and Norepi

Question 27

Metabolic changes after Aortic Cross Clamp ↓ in... (3)

Answer 27

Total Body O2 Extraction Total Body CO2 Production Total Body O2 consumption

Question 28

↑ in arterial BP above the clamp +Total body O2 consumption = What intraop intervention??

Answer 28

↓ Afterload or Shunts and aorta to femoral bipas -Sodium Nitroprusside -IA -Milirinone

Question 29

↓ in arterial Bp below the clamp + ↓ in total body CO2 production = What intraop intervention??

Answer 29

↓ Preload Nitroglycerin OR Art to femoral bypass

Question 30

↑ wall motion abnormalities and LV wall tension + ↑ mixed venous O2 sat = What intervention???

Answer 30

Renal Protecion -Fluid Administration -Manitol -Lasix -Dopamine -N-acetylcystine -Renal Cold perfusion

Question 31

Pretreatment with an _______ was associated with a complete return of renal blood flow & glomerular filtration rate to baseline after the unclamping of the aorta, whereas in control animals the renal blood flow returned to only approximately 50% of baseline values

Answer 31

Pretreatment with an __ACE inhibitor___ was associated with a complete return of renal blood flow & glomerular filtration rate to baseline after the unclamping of the aorta, whereas in control animals the renal blood flow returned to only approximately 50% of baseline values

Question 32

Where is the Artery of Adamcowitz locatred

Answer 32

Usually T8-T12

Question 33

How do you protect the spine during Descending Thoracis Aneurism repair?

Answer 33

Lumbar Drain keep ICP from 10-12 Do not drain more than 20 cc/hour

Question 34

Question 35

What type of Aneurism is this

Answer 35

Debakey I / Standford A

Question 36

What type of Aneurism is this?

Answer 36

Debakey 2 Standford A

Question 37

What type of Aneurism is this?

Answer 37

Debakey 3 / Standford B

Question 38

2 Anesthesia considerations for Thoracic Aneurysm Repair?

Answer 38

DL ETT if L Thoracotomy R side A line

Question 39

Question 40

Main advantage of Endovascular AA repair?

Answer 40

No Cross Clamp