Exam 1 Highlighted Material Flashcards
B Blockers in Vascular Surgery.
When Should they be started?
Target HR?
Started >1 day (Days-weeks before)
Target HR 50-60
When should a statin be started on a vascular surgery patient?
30 days
What is the #1 compliucation in vascular surgery?
MI not Stroke. Stroke is number 2
3 biggest RF in vascular surgery
DM, Tobacco and Hyperlipdemia
Indications for CEA
–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
What is luxury perfusion?
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
What is cerebral steal syndrome?
A PaCO2 increase results in vasodilation of normal
blood vessels that will shunt blood away from the
diseased area – hypercapnia
What is the robin hood effect
During times of low PaCO2 vasoconstriction occurs but the diseased vessls stay dialated robbing the healthy tissue of CBF
Pitfalls of Shints during CEA
- Trauma to the vessel
- Embolism– Air or thrombus formation
What is the BP goal during cross clamping during CEA?
20 % ↑ in BP for colateral perfusion
During CEA what causes sudden hypotension and bradycardia ? how can this be avoided? What Complication can happen from this treatment?
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
Risk factors for AAA
Male >female
50-80 yo
Smoker
Family history
HTN, HLD, CAD, PVD
COPD
Caucasion
Contraindications for elective AAA repair
Recent MI
Chronic Renal Insufficiency
Severe Pulmonary dysfunction
intractable Pectoralis Angina
Law of Laplace equation
T (Wall Tension) = R (Radius of vessel) x P (Transmural Pressure)
Respiratory Preop preparation for AAA
Smoking Cessation,
Bronchodilators
IS
Chest PT
↓ Risk of Postop complications
CV Preop for AAA
Hx of CAD? probably
Check BP in both arms use the higher for A line
HTN ↑ risk of rupture; Tight BP control
Renal Prop AAA
Renal insufficiency is common in these patients secondary to HTN DM and atherosclerosis repurfusion
Usually dry d/t radiology studies and bowel prep
Heme Prop AAA
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
Anesthesia Goals for AAA
Keep them warm
Keep HR slow
Avoid Anemai
Prevent HTN
Response to Aortic cross clamping is directly related to …
Placement of clamp (usually infrarenal
Volume status
Cardiac reserve
Application of Aortic clamp causes
Central Hypervolemia
shunting blood proximal to clamp causing ↑ in venous return
Release of Clamp causes
Central hypovolemia
Capillary beds leak d/t rush of blood to the LE causing ↓ in venous return
_______ above the clamp and _____ below the calmp
____HTN___ above the clamp and __Hypotension___ below the calmp
Aortic Cross Clamping Hemodynamics,
↑ in … (7)
- Arterial Wall motion above clamp
2.Segmental Wall Abnormalities
3, Ventricular Wall motion (contractility) - PAOP
- PAP
- Coronary BF
- Myocardial O2 Demand
Aortic Cross Clamping Hemodynamics,
↓ in… (4)
- Renal Bloof Flow
- Blood Pression Below Clamp
- EF
- CO
Metabolic changes after Aortic Cross Clamp
↑ in … (3)
- Resp Alkilosis and Metabolic Acidosis
- Mixed Venous O2
- Epi and Norepi
Metabolic changes after Aortic Cross Clamp
↓ in… (3)
Total Body O2 Extraction
Total Body CO2 Production
Total Body O2 consumption
↑ in arterial BP above the clamp +Total body O2 consumption = What intraop intervention??
↓ Afterload or Shunts and aorta to femoral bipas
-Sodium Nitroprusside
-IA
-Milirinone
↓ in arterial Bp below the clamp + ↓ in total body CO2 production = What intraop intervention??
↓ Preload
Nitroglycerin
OR Art to femoral bypass
↑ wall motion abnormalities and LV wall tension + ↑ mixed venous O2 sat = What intervention???
Renal Protecion
-Fluid Administration
-Manitol
-Lasix
-Dopamine
-N-acetylcystine
-Renal Cold perfusion
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
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
Where is the Artery of Adamcowitz locatred
Usually T8-T12
How do you protect the spine during Descending Thoracis Aneurism repair?
Lumbar Drain keep ICP from 10-12
Do not drain more than 20 cc/hour
What type of Aneurism is this
Debakey I / Standford A
What type of Aneurism is this?
Debakey 2 Standford A
What type of Aneurism is this?
Debakey 3 / Standford B
2 Anesthesia considerations for Thoracic Aneurysm Repair?
DL ETT if L Thoracotomy
R side A line
Main advantage of Endovascular AA repair?
No Cross Clamp
