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CV Anesthesia > Test 2 > Flashcards

Test 2 Flashcards

1
Q

_________ is useful during OPCAB despite cardiac displacement

A

TEE

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2
Q

Heart valve surgery continues to involve

A

Complex hemodynamic management

TEE assessment

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3
Q

___________ requires use of 3D TEE

A

Mitral Valve Repair

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4
Q

Valuable resource in management of cardiopulmonary instability in noncardiac patients

A

TEE

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5
Q

Benefits of TEE during CAB

A
  • Monitor ischemia
  • Hemodynamic performance
  • presence of ventricular air
  • cannula placement
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6
Q

Management of patients with aortic stenosis

A
  • Slow HR
  • Higher perfusion pressure
  • Monitor hemodynamic performance
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7
Q

Management of anesthesia in paitents with aortic insufficiency (regurgitation)

A
  • faster HR
  • optimal filling volume
  • minimize regurgitant flow
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8
Q

Management of patients with mitral insufficiency

A
  • faster HR
  • optimal filling volume
  • minimize regurgitant flow
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9
Q

Management of patients with mitral stenosis

A
  • slower HR
  • optimal filling volumes
  • maintain RV function
  • manage pulmonary HTN
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10
Q

TEE utilization in pt with aortic valve disease

A
  • measure aortic valve area/gradient
  • aorta and annular dimensions
  • assess for coexisting disease
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11
Q

Utilization of TEE in patients with mitral valve disease

A
  • measure mitral valve area/gradients
  • mitral valve anatomy
  • quality of repair
  • pulmonary HTN
  • biventricular function
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12
Q

Management of patient with aortic stenosis presenting for TAVR

A
  • heart rate manipulation
  • hemodynamic maintenance
  • assess valve position
  • assess paravalvular leaks
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13
Q

Qualitative TEE findings include

A

Volume status
Pericardial effusion
Contractility/bi-V function
Simple congenital cardiac defects

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14
Q

Quantitative TEE findings

A

PAP
CO
Valve function and area
Aorta dimension

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15
Q

Mitral stenosis is characterized by

A

Decreased SV

Decreased BP

Restricted diastolic inflow

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16
Q

Mitral stenosis pressure volume loops characteristically have

A

Decreased filling

Lower ventricular volumes

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17
Q

Mitral stenosis patients typically have

A

Pulmonary HTN and tricuspid regurg

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18
Q

Mitral stenosis patients typically have symptoms at rest when valve area

A

< 1.5cm

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19
Q

Pathological features of mitral stenosis include

A

LA enlargement

Decreased LV filling

Heart rate dependent CO

Sinus rhythm dependent BP

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20
Q

Moderate-severe mitral stenosis is associated with

A
  • orifice area <1.5cm
  • pressure half time >150ms
  • pressure gradient across the valve >5mmHg
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21
Q

Mitral regurgitation pressure volume loops characteristically have

A

Higher ventricular volumes and lack isovolumetric contraction component

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22
Q

Hemodynamic goals for mitral stenosis include

A

Slow-normal HR

Increased SVR

Maintenance of normal PVR

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23
Q

Moderate-severe mitral stenosis is often associated with

A

RV failure

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24
Q

Pathological features of mitral regurgitation include

A

LA enlargement

Eccentric LV hypertrophy
- accommodate increased LV volume and decreased forward SV

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25
Moderate/severe mitral regurgitation is associated with a regurgitant jet/vena contracta __________ and regurgitant jet that occupies at least
>3-6mm 2/3 LA by TEE
26
Hemodynamic goal in pt with mitral regurgitation
Normal-fast HR Low-normal SVR Preservation of intravascular volume/contractility
27
Post-bypass management of mitral valve surgery patients typically employs
Inotrope Lower BP Faster HR
28
Mitraclip is now being used for
Inoperable patients Employs Alfieri stitch and TEE
29
Mitra regurgitation limits
Net forward flow
30
Principle compensatory mechanisms for mitral regurgitation
Fluid retention Eccentric hypertrophy
31
Mitral stenosis results in
LA hypertrophy Fixed SV
32
Mitral valve stenosis results in PCWP
Always overestimating LVEDP
33
During induction/maintenance of mitral stenosis
Avoid hypercapnia/hypoxia. (Increases PVR and causes RV failure)
34
Acute treatment of pulmonary HTN and RV failure
Hyperventilation High FiO2 (prevent HPV) Nitric Oxide NTG Isuprel, dobutamine, epi, Miri one, NE RVAD IPABP IABP
35
RV dysfunction is extremely sensitive to
Afterload of PA Optimal ventilation is key
36
Induction and maintenance with mitral regurgitation
Faster, fuller, vasodilates
37
Pressor for mitral regurgitation
NE Avoid neo
38
Benefits of TEE during CAB
Monitor ischemia Monitor hemodynamic performance ID presence of ventricular air Cannula placement
39
Management of patients with aortic stenosis
Slower HR Higher perfusion pressures Monitor hemodynamic performance
40
Management of anesthesia in patients with aortic insufficiency
Faster HR Optimize filling volume Minimize regurgitant flow Faster Fuller Forward
41
Management of patients with mitral insufficiency
Faster HR Optimal filling volume Minimize regurgitant flow faster fuller forward
42
Management of patients with mitral stenosis involves
Slower HR Optimal filling volumes Maintenance of RV function Management pulmonary HTN
43
TEE is used in pt with aortic valve disease to
Measure AV area/gradient Aorta and annular dimensions Assess for coexisting disease
44
TEE is utilized in patients with mitral valve disease to
Measure MV valve area/gradient MV anatomy Quality of repair Pulmonary HTN Biventricular function
45
Management of patients with aortic stenosis presenting for TAVR
HR manipulation Maintenance of hemodynamics Assess valve position Assess for paravalvular leaks
46
Qualitative TEE findings
Volume status Pericardial effusion Contractility/Bi ventricular function Simple congenital cardiac defects
47
Quantitative TEE findings
PAP CO Valve function/area Aorta dimensions
48
How body compensates fro heart valve disease
SNS activation Increasing intravascular volume Modified chamber dimensions
49
Aortic stenosis pressure volume loops characteristically have
Higher intraventricular pressure-volume relationships
50
Aortic regurgitation pressure volume loops characteristically have
Higher ventricular volumes Lack isovolumic relaxation component
51
Pathological features of aortic stenosis
Concentric ventricular hypertrophy Pressure overloading/high LV tension Increased MVO2
52
Severe/critical AS is associated with AV area Aorta/LV gradient Peak aortic jet velocity
AV valve area <1cm Aorta/LV gradient >40mmHg Peak aortic jet velocity >4m/s
53
Symptomatic aortic stenosis and/or NYHA III-IV should receive what for major surgery
Arterial line PAC/TEE
54
Hemodynamic goals in paitents with aortic stenosis include
Slow-normal heart rate Normal SVR Preservation of LV contractility
55
Anesthetic considerations prior to CPB include
Assess aorta for plaque Heparinization (300-400units/kg) ACT >400seconds
56
Best TEE window for assessing ventricular function and filling is
Transgastric view
57
Hemodynamic goals post CPB in patients with AS include
Maintain optimal LV filling SR Judicious use of inotrope
58
Mediastinal bleeding >_____ necessitates re-exploration in OR
300ml/hr
59
Cerebral protection during circulatory arrest may include
Profound hypothermia Ice to head Propofol infusion Monitor cerebral oxygen saturation
60
Anesthesia considerations for patients with hypertrophic cardiomyopathy (HOCM) include
Maintain adequate intravascular volume Increased SVR Myocardial depression Deep anesthesia
61
Pathological features of aortic regurgitation include
Eccentric LV hypertrophy Volume overload Decreased net SV
62
Severe/moderate aortic regurgitation is associated with Vena contracta Pressure half time Regurgitant jet
Vena contracta >6mm Pressure half time <200 Regurgitant jet >65% width of LV outflow tract
63
Anesthesia management of patients with aortic regurgitation includes
Maintenance of faster HR Lower SVR Preservation of contractility

CV Anesthesia (4 decks)

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