Review Deck 4 Flashcards
To come off of bypass,
core temp must be >35
corrected labs
heart paced or SR at sufficient rate of 90
Complications of aortic cross clamp include
hemorrhage
dislodgement of atheromas
aortic dissection
Protamine is given slowly because it can cause
hypertension, right heart failure, and hypotension related to type 1 histamine release
Protamine is derived from
salmon sperm
Contraindications to heart transplant are
> 70
chronic renal dysfunction
obesity
Platelet function is lost or altered by
hemodilution
hypothermia
contact with CPB circuit
_____ is the leading cause of periop mortality at the time of vascular surgery
Coronary artery disease
-silent or unrecognized MIs are possible
Coexisting disease for vascular surgery include
DM HTN renal impairment pulmonary disease systemic atherosclerosis CAD
Drug eluting stents should be continued for
6 months on dual anti-platelet therapy
_____ strongly predicts long-term mortality
chronic renal disease
The principle cause of CAD is
atherosclerosis
Best monitor of neurological function for carotid endarterectomy is
awake anesthesia
Arterial blood pressure should be maintained in the _______ range throughout the procedure & during the period of carotid clamping to increase collateral flow & prevent cerebral ischemia
high-normal range
Surgical manipulation of carotid sinus includes
baroreceptor reflex leading to decreased HR & BP
-tell surgeon to stop, infiltrate with lidocaine, give glyco
Describe the difference in symptoms between aortic aneurysm compared to dissection
aneurysm- asymptomatic
dissection- severe sharp pain
This concept applies to aneurysms
Law of Laplace
Elective repair of aneurysm is for AAA
6 cm or larger
becomes symptomatic
more than 0.5 cm in a 6 month period
Classic triad for rupture AAA:
hypotension
back pain
pulsatile abdominal mass
For patients who you’re concerned about giving contrast to
limit the contrast load & provide adequate hydration to decrease the viscosity of iodine based dyes
Artery of adamkiewicz is
T9-T12
Describe what happens above and below the clamp
arterial hypertension above
hypotension below
Cross clamping of the thoracic aorta decreases
total body O2 consumption by approximately 50%
These drugs can be used for renal protection
mannitol or dopamine
The strongest predictor of postoperative renal dysfunction is
preoperative renal insufficiency
During cross-clamp, the lower part of the body
should not be warmed because it can increase metabolic demands
Spinal cord protection strategies include
CSF drainage
mild hypothermia
limit cross clamp <30 minutes
monitor SSEPs/MEPs
Goals during cross clamping include in respect to afterload, preload, CO
reduce afterload
maintain normal preload
maintain CO
Hemodynamic response to unclamping can lead to
hypotension–> prepare to decrease vasodilators, inhaled anesthetics, increased fluid administration, consider cross clamp reapplication
