Transfer to SICU

Question 1

Transport to SICU

Answer 1

take emergency drugs
call PMTs for assistance
fellow goes with you

Question 2

hazards in transfer

Answer 2

air, clot dislodgement

pulling out line, chest tubes, foley

Question 3

S/S of end-stage tamponade

Answer 3

hypotension
low voltage ECG
distant heart tones
widened mediastinum

Question 4

early s/s pericardial tampanode

Answer 4

impaired diastolic filling
equalization of right and left heart pressures
pt compensates for significant amounts of fluid and then decompensates quickly

Question 5

anesthetic of choice for pericaridal tampanode

Answer 5

ketamine?

Question 6

circualty arrest indications

Answer 6

aortic aneurisms, aortic root repair, congenital heart defects

• involves removal of perfusion cannula and cessation of CPB
• myocardial and cerebral protection
• potential for large blood loss post-arrest

Question 7

maximum duration of circulatory arrest

Answer 7

one hour

Question 8

cerebral protection: cooling

Answer 8

done with CPB to 18 degrees c
wrap head in ice
monitor the temp
retrograde perfusion @ 40ml/min
-SVC to IJ through the brain bleed out to carotid and vertebral artiers
-provides 02 to the brain, fluses out air and potential thrombi

Question 9

Pharmacologic cerebral protectants

Answer 9

thipoental
mannitol
methylprednisilone

Question 10

Dose and goal of Thiopental in cerebral protection

Answer 10

aim is burst suppression on EEG

15-20 mg/kg

Question 11

Dose and goal of Mannitol in cerebral protection

Answer 11

decreases edema, renal protectant

.25-.5 G/kg

Question 12

Dose and goal of methylprednisilone in cerebral protection

Answer 12

30 mg/kg

membrane stabilization

Question 13

Off pump CABG approach

Answer 13

Mini thoractomy approach

midline sternotomy

Question 14

benefits of off pump CABG

Answer 14

avoid systemic inflammatory response seen post-bypass

avoid problems with hypothermia, cannulation, cardiac arrest and cardioplegia

avoid issues with organ perfusion with non-pulsatile flow

Question 15

preperation for off pump CABG

Answer 15

standard monitors and induction
same set up
have lots of pressors available
Heaprin for ACT 250-300
General +/- intercostal blocks

Question 16

intraop off pump CABG considerations

Answer 16

-use of stabilizing devise reduces CO
-manipulation of heart and placement of distal grafts produces dramatic cardiac dysfunction and arrythmias
-reduces venous return to heart
reduces coronary blood flow with reflexive tachycardia
-ISCHEMIA
-be prepared for profound hypotension

Question 17

ischemic preconditioning during off pump CABG

Answer 17

• brief repetivite occulsions of artery to be bypassed
• preconditioned hearts showed less decrease in LV dysfunction after ischemia and arrythmias
• inconsistnet

Question 18

Proximal anastomosis

Answer 18

-partially occluding aortic clamps

SBP

Question 19

proximal anstomosis interoperative goals

Answer 19

maintain CPP
prevent ischemia
maintain CO
euvolemia
rest the heart bw manipualtions
large dose of pressors and/or vol

Question 20

when to go on bypass? (off pump CABG)

Answer 20

• technical reason or sudden servere decompensation following occlusion of coronary artery
• deterioration from a previous steady state that doesn’t respond to aggressive tx