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Cardiothoracic Princ. III > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

T/F: Perioperative β- blockade started within 1 day or less before noncardiac surgery increases the risk of hypotension, bradycardia, stroke, and death.

A

TRUE

Perioperative β- blockade started within 1 day or less before noncardiac surgery prevents nonfatal myocardial infarctions (MIs) BUT ALSO increases the risk of hypotension, bradycardia, stroke, and death.

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1
Q

β-blockade therapy should be instituted _______ days before surgery and titrated to a target
heart rate between __ and ___ beats per minute (bpm)

A

7-10 days
50-60 bpm

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2
Q

List some cardioprotective effects of statins:

A
  1. reduce vascular inflammation
  2. decrease the incidence of thrombogenesis
  3. enhance nitric oxide bioavailability
  4. stabilize atherosclerotic plaques
  5. lower lipid concentrations
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3
Q

a statin should be instituted __ days prior to the surgical procedure and continued
throughout the postoperative period

A

30

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4
Q

List Some Risk Factors Related to the Development of Atherosclerotic Lesions (13):

A
  1. Advanced age
  2. Smoking
  3. Hypertension
  4. Diabetes mellitus/insulin resistance
  5. Obesity
  6. Family history/genetic predisposition
  7. Physical inactivity
  8. Male gender
  9. Hyper or Hypohomocysteinemia
  10. Elevated C-reactive protein
  11. Elevated lipoprotein
  12. Hypertriglyceridemia
  13. Hyperlipidemia
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5
Q

Conditions and Traits Associated With Development of Abdominal Aortic Aneurysm (10)

A
  1. Smoking
  2. Older age
  3. Gender (more common in males than in females)
    Family history
  4. Coronary artery disease
  5. High cholesterol
  6. Chronic obstructive pulmonary disease
  7. Height (per 7-cm interval)
  8. Hypertension
  9. Peripheral vascular occlusive disease
  10. Whites
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6
Q

Which risk factor is the most highly correlated with AAA?

A

Smoking is the risk factor that is most highly correlated with
AAA.

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7
Q

Surgical intervention is recommended for
AAAs ___ cm or greater in diameter

A

5.5 (5)

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8
Q

T/F: An aneurysm has the potential to rupture regardless of its size.

A

TRUE, an aneurysm has the potential to rupture regardless of its size.

As the diameter of the aneurysm increases in size, however, the risk of rupture increases.

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9
Q

T/F: Prophylactic coronary revascularization reduces the incidence of perioperative cardiac events.

A

False

Prophylactic coronary revascularization does NOT reduce the incidence of perioperative cardiac events.

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10
Q

What is the primary method of intraoperative cardiac assessment in patients
undergoing surgery on the heart and the aorta?

A

TEE

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11
Q

what is a good analgesic option for patients with severely decreased ejection fraction?

A

Dexmedetomidine

functions to inhibit the sympathetic nervous system by decreasing central catecholamine release, does not inhibit respiration, and provides postoperative analgesia

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12
Q

what considerations should be taken with inhalation anesthetics for patients with CAD?

A

all inhalation anesthetics may depress the myocardium and cause hemodynamic instability. therefore high concentrations of inhalation agents should not be used in patients with a moderate to severe decreased ejection fraction

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13
Q

benefits of epidural anesthesia (8)

A

(1) decreased preload and afterload,
(2) preserved myocardial oxygenation,
(3) reduced stress response,
(4) excellent muscle relaxation,
(5) decreased incidence of postoperative thromboembolism, (
6) increased graft flow to the lower extremities, (
7) decreased pulmonary complications, and
(8) improved
postoperative analgesia

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14
Q

potential disadvantages of epidural anesthesia

A

possibility of an epidural hematoma (increases with anticoagulation) and severe hypotension during blood loss or unclamping

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15
Q

T/F: General anesthesia with TEA does not increase the risk of mortality, MI, or
neurologic complications compared to GA alone

A

TRUE

The use of a combined general anesthesia and epidural anesthesia provides the benefits of epidural anesthesia with the ability to provide amnesia and controlled ventilation.

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16
Q

Urinary output parameter for vascualr surgery

A

urine output of at least 1 mL/kg/hr.

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17
Q

Cardiovascular function must be closely monitored in the ICU for at least ___ hours after surgery

A

24

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18
Q

most common symptoms of a ruptured AAA

A

severe abdominal discomfort or pain
altered LOC caused by hypotension
pulsatile abdominal mass

other: syncope, groin/flank pain, hematuria, groin hernia

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19
Q

A patient with known AAA and cardiac disease is hypotensive in Preop. what should be done?

A

immediately transfer to OR for surgical exploration

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20
Q

Actions to protect kidneys with clamping of the aorta

A

minimize nephrotoxic medications such as NSAIDs (i.e. Toradol) and aminoglycoside antibiotics (i.e. gentamycin)

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21
Q

highest risk of kidney failure with which type of AAA

A

suprarenal clamp-time longer than 30 minutes

22
Q

most significant in decreasing spinal ischemia?

A

short cross-clamp time

23
Q

T/F: bair hugger is an appropriate method of maintaining normothermia during vascular surgery

A

FALSE

Bair huggers are contraindicated during vascular surgery clamping

24
Q

most common origin of artery of adamkiewicz

A

T9-T12

25
Q

What is a normal range for intracranial pressure (ICP) in adults?

A

10-15 mm Hg

26
Q

What is the most common postoperative complication after carotid endarterectomy (CEA)?

A

Hypertension

27
Q

Which is a disadvantage of aortic cross-clamping without bypass?

A

Risk of spinal cord ischemia

28
Q

Which factor does NOT predispose to postoperative renal dysfunction?
* A. Prolonged aortic cross-clamp time
* B. Preexisting renal disease
* C. High intraoperative urine output
* D. Use of nephrotoxic agents (i.e. NSAIDs, aminoglyoside abx)

A

C. High intraoperative urine output

29
Q

What is the primary purpose of transesophageal echocardiography (TEE) in aortic surgery?
* A. Monitor renal function
* B. Assess cardiac function
* C. Evaluate spinal cord perfusion
* D. Measure intracranial pressure

A

B. Assess cardiac function

30
Q

What hemodynamic change occurs below the aortic cross-clamp?

A

Decreased blood pressure

31
Q

Which medication class is suggested to be started 30 days prior to vascular surgery and continued postoperatively?

A

Statins

32
Q

Symptoms of abdominal aortic aneurysm (AAA) rupture

A

Hypotension
Pulsatile abdominal mass
Back pain

33
Q

What interventions helps prevent spinal cord injury during thoracic aortic surgery?

A

Hypothermia
CSF drainage

34
Q

What is a common complication of aortic dissection?
* A. Paraplegia
* B. Hypertension
* C. Renal failure
* D. Stroke

A

C. Renal failure

35
Q

Which intervention is appropriate for managing metabolic acidosis after releasing an aortic clamp?
A. Administering sodium bicarbonate
B. Increasing minute ventilation
C. Both A and B
D. Neither A nor B

A

C. Both A and B

36
Q

During aortic cross-clamping, what occurs above the clamp?

A

Hypertension

37
Q

If clamping is needed in CEA, cerebral perfusion is dependent on…

A

MAP

When carotid artery cross-clamping without shunting occurs, MAP values must be 20% or greater of the patient’s preoperative MAP to help ensure adequate cerebral perfusion through the contralateral carotid artery and
decrease the possibility of postoperative cognitive dysfunction.

38
Q

Goals for EVAR (Select 2):
a. hemodynamic stability
b. minimize blood loss
c. ensure adequate analgesia
d. BP control with aortic cross-clamp

A

a. hemodynamic stability
c. ensure adequate analgesia

The goals for intraoperative management for EVAR include maintaining hemodynamic stability, providing analgesia and anxiolysis, and being prepared to rapidly convert to an open procedure.

39
Q

Physiologic effect of aortic cross-clamping

A

metabolic acidosis
respiratory alkalosis

40
Q

Mixed venous oxygen saturation (SvO2) increases when clamping occurs above the _______ due to reduced oxygen consumption.

A

CELIAC AXIS

41
Q

Arterial pressure, blood flow, and oxygen consumption _______ below the clamp

A

DECREASE

42
Q

What decreases with cross-clamping?

A

Left ventricular ejection fraction
Cardiac output
O2 consumption
Renal blood flow
BP below the clamp

43
Q

What increases with cross-clamping?

A

MAP
SVR
Preload
Venous return
Coronary blood flow
Pulmonary artery wedge (PAOP)
AoDBP
Myocardial O2 consumption
SvO2 or mixed venous oxygen saturation

44
Q

What decreases with release of the cross-clamp?

A

MAP
SVR
Preload
Venous return
Contractility
Coronary blood flow
Myocardial O2 consumption
RENAL BLOOD FLOW IS STILL A RISK DUE TO DECREASED MAP, SVR, AND CO!
SvO2 or mixed venous

45
Q

What increases with release of the cross-clamp?

A

Total body oxygen delivery and consumption
Pulmonary artery pressure
PAOP, PVR

46
Q

Strategies to reduce drop in SVR and MAP prior to release of cross-clamp?

A

IVF
Shorter cross-clamp times
Gradual/partial release of clamp
Vasopressors and/or inotropes
Decrease anesthetic depth

47
Q

What does an EKG show

A

Ischemia
Myocardial hypertrophy

48
Q

How do you increase O2 blood supply to the coronaries? (Select 3):
a. Hemoglobin
b. Diastolic time
c. Systolic time
d. Arterial oxygen content
e. Preload
f. Afterload

A

a. Hemoglobin
b. Diastolic time
d. Arterial oxygen content

49
Q

Why is nitrous not used/contraindicated in thoracic surgery?
a. increased atelectasis in dependent lung
b. enhances HPV
c. increases PVR or pulmonary artery pressure

A

a. increased atelectasis in dependent lung
c. increases PVR or pulmonary artery pressure

50
Q

Most common site of aneurysm

A

Infrarenal

51
Q

Most common postop complication with CEA

A

Hypertension

52
Q

What causes cerebral steal?

A

Hypercarbia (causes vasoDILATION)

Cerebral steal occurs when vasodilation in non-ischemic areas diverts blood away from ischemic brain regions, exacerbating ischemia.

53
Q
A

Cardiothoracic Princ. III (8 decks)

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