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Princples C > Major Vascular II > Flashcards

Major Vascular II Flashcards

1
Q

what factors contrubute to the development of an aneurysm

A
  • adventitial elestin layer degradation
  • chronic inflammation
  • concomittant aortoiliac occlusie disease
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2
Q

dissection is a tear in the

A

intimal layer

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3
Q

risk factors for abdominal aneurysm

A
  • smoking
  • family history
  • atherosclerotic disease
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4
Q

risk factors for thoracic aneurysm

A
  • congenital syndromes
  • trauma
  • Ao cannulation
  • bicuspid Ao valve
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5
Q

what is the risk for an aneurysm rupture for 4-5.9cm

A

0.5 - 15%

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6
Q

What size aneurysm will likely result in a patient needing elective surgery

A

> 6cm

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7
Q

which aneurysm type is likely to result in respiratory failure and paraplegia?

A

Thoracic

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8
Q

Between saccular and fusiform aneurysm which type is more common?

A

fusiform

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9
Q

a patient with stridor, dysphagia, and upper body edema is likely to have what type of aneurysm

A

thoracic

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10
Q

what will you see on xray for a thoracic aneurysm?

A

widened mediastinum

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11
Q

describe a debakey I aortic dissection

A

proximal aorta, Ao arch, and descending aorta. A large percentage of aorta has dissected. 60%.

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12
Q

Debakey II is what percentage of dissection? Proximal or distal?

A

10-15%
Proximal

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12
Q

What are the general abdominal aneurysm symptoms

A
  • hypotension
  • back pain
  • pulsatile mass
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13
Q

where do abdominal aneurysms rupture into? is it good or bad?

A

left retroperitoneum
Good -> helps tamponade the bleeding and helps proximally control bleeding
(keep patient hypotensive to reduce bleeding, dont transfuse)

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14
Q

Many abdominal aneurysms are diagnosed ___

A

incidentally

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15
Q

Pre op considerations for patients with aneurysms

A
  • Previous MI/ Vasculopath: EKG, CHF, CEA, valve dysfunction, echo?
  • Hx of COPD/Smoking: PFTs, ABGs
  • Renal: hydration, avoid low CO, avoid nephrotoxic drugs
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16
Q

Induction for aneurysm patients

A
  • minimize hypotenion and hypertension
  • DLT for surgical exposure
  • CVL, flow trac, vigeleo
  • A-line
  • Hot line/ 2 PIVs
  • blood
  • warming / underbody fluid blanket
  • heparin, ACTs, protamine
  • Consider renal clearance of NMBDs (cisatricurium, Rocuronium has minimal renal clearance)
17
Q

What considerations are important with a trans-peritoneal approach for AAA repair

A

fluid shifts, ileus, pulmonary complications, longer ICU stay

18
Q

A retroperitoneal approach is indicated for what patients?

A

obesity, COPD, previous abdominal surgeries

19
Q

benefits of retroperitoneal approach

A

less fluid shift/ pulm/ abd issues

20
Q

drawbacks of retroperitoneal approach

A

more hernias, chronic wound pain, less visualization

21
Q

Concerns with Ao clamping

A

significant increase in SVR
increase in catecholamine release
significant decrease in CO
Renal vascular resistance increased by 70%
active venoconstriction (increase preload)

22
Q

What complication can increase mortality by 4-5x

A

Acute renal failure r/t Ao cross clamp

23
Q

After cross clamp we can give small boluses of _______

A

Vasodilator

reduce afterload, promote blood flow to renal/spinal, etc

24
Q

What anesthesia technique can help with postop pain and intraoperative SVR issues

A

Epidural catheter

25
Q

Aortic unclamping concerns

A

substantial drop in SVR
hypotension
hypoxic vasodilation
accumulation of metabolites

26
Q

What intervention can help with preload and hct while cross clamp is on

A

Volume, packed cells

27
Q

Interventions for aortic clamp removal

A
  • drop volatiles
  • give fluids
  • give vasoconstrictors
  • frequent labs (hct, K+, ABGs)
  • calcium, bicarbonate, low dose pressors
28
Q

What are MAP targets for above and below clamp

A

100 MAP above
50 MAP below

29
Q

Where is the clamp typically applied

A

Just distal to sub or between sub and common carotid

30
Q

ACT target

A

250

31
Q

SSEPs represent the ____ column but we are causing ischemia to the ____ portion of the spinal cord

A

dorsal ; Anterior

32
Q

complications of aneurysm repair

A

paraplegia/ paresis

33
Q

anterior spinal artery think ____ function

A

motor

34
Q

Posterior spinal artery think ____ function

A

sensory

35
Q

anterior radicular artery supplies

A

T9- T11

36
Q

what invasive intervention can help maintain lower body perfusion

A

left heart bypass

37
Q

DHCA temperature

deep hypothermic circulatory arrest

A

18-20c

38
Q

what is the safe zone time for DHCA

A

30 minutes

39
Q
A
40
Q
A

Princples C (2 decks)

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