PVD

Question 1

Atherosclerosis risk factors

Answer 1

Diabetes Mellitus
Advanced age
Male gender
Obesity and physical inactivity
Sedentary lifestyle
Essential HTN
Smoking
Dyslipidemia
Hyperhomocysteinemia
Family Hx of Premature atherosclerosis

Question 2

S/S of atherosclerosis

Answer 2

intermittent claudication
cool/cold feet to touch
pain in the legs while lying flat and relieved by a sitting position
loss of pulses in legs or feet
pale color when legs are raised up
dependent rubor (redness when legs are in a dependent position)
shiny skin
loss of hair on feet
Thickened toenail (may have fungal infections)

Question 3

Impact of PVD on Anesthetic Management

Answer 3

Principal risk during reconstructive surgery is associated with atherosclerosis, especially Ischemic Heart Disease. Pt. with PVD has 3-5x greater risk of MI, stroke and death.

CABG operations are usually performed before surgery on the peripheral vasculature in patients who experience angina and claudication.

Question 4

General Considerations for Lower Extremity Revascularization

Answer 4

Possible complications of anesthesia & surgery may impose additional burdens
Hemorrhage
Infection
Pulmonary embolism
Cardiac complications
Myocardial infarction/ischemia
Low cardiac output
Pulmonary edema 
Lower extremity hypo-perfusion or ischemia if Lithotomy position is used

Question 5

Peripheral Revascularization Monitoring

Answer 5

Pts typically present with CAD, diabetes, HTN
Preop- make sure pt takes beta-blockers and/or other chronic medication
Introp-arterial line
Ability to monitor intravascular volume by either CVP and CO or foley
Estimated blood loss
Estimated third space

Question 6

Regional Anesthesia: Some perceived advantages of regional anesthesia

Answer 6

1) increased graft blood flow
2) less increase in SVR with cross- clamping
3) postoperative pain relief
4) less activation of the coagulation system.

Assess for coagulopathy
If considering regional, Spinal may be best, to avoid hematoma
Studies have shown no difference between RA and GA in terms of cardiopulmonary complications
Significant difference in complication rate in terms of graft occlusion

Question 7

Anesthetic management

Answer 7

Consider co-morbidities
Medication Hx- impact on anesthetic delivery
End organ Perfusion & Oxygenation-maintain
Blood gases-electrolyte & PH changes
Cross clamp- heparin administration/ record time /reversal?