Vasc Ppt 2

Question 1

What is the purpose of heparin during a carotid endarterectomy (CEA) procedure?

Answer 1

To prevent thromboembolic complications.

The standard dose is 100u/kg, with a baseline ACT checked prior to administration.

Question 2

What is the target ACT level before internal carotid artery clamping during CEA?

Answer 2

250s – 375s.

The ACT should be checked after administering heparin and monitored every 20-30 minutes.

Question 3

What is the role of protamine in the CEA procedure?

Answer 3

To reverse the effects of heparin.

It is important to check the ACT after administering protamine to ensure it is returning close to baseline.

Question 4

Who decides if a patient needs a shunt during a CEA?

Answer 4

The surgeon.

This decision is typically made during the time-out process.

Question 5

What is the purpose of inserting a shunt during CEA?

Answer 5

To divert blood around the surgical site after clamping the carotid artery.

The shunt creates a temporary blood flow channel.

Question 6

When is the shunt removed during CEA?

Answer 6

Before restoring blood flow after plaque removal and artery closure.

Question 7

What is the recommended emergence drug for CEA procedures?

Answer 7

Precedex.

It is preferred for its minimal side effects and effectiveness.

Question 8

What is the gold standard anesthetic technique for CEA?

Answer 8

Regional anesthesia, specifically a superficial cervical plexus block (C2-C4 dermatomes).

Question 9

What are the pros of using regional anesthesia for CEA?

Answer 9

• Greater stability of BP
• Easy cerebral monitoring
• Avoid intubation
• Less need for negative inotropic agents
• Fewer episodes of EEG ischemia
• Reduced costs

Question 10

What are the cons of using regional anesthesia for CEA?

Answer 10

• Patient panics
• Sudden loss of consciousness
• Onset of seizures
• Difficulty controlling the airway

Question 11

What is hyperperfusion syndrome?

Answer 11

A rare but serious complication that can occur after CEA, characterized by a sudden increase in blood pressure and blood flow in the brain.

Symptoms may include severe headache, nausea, vomiting, confusion, and seizures.

Question 12

What are the risk factors for hyperperfusion syndrome following CEA?

Answer 12

• High blood pressure after surgery
• Older age
• Poorly controlled preoperative hypertension
• Previous history of stroke or TIA

Question 13

What is the primary symptom of an aortic aneurysm?

Answer 13

75% are asymptomatic, often discovered incidentally.

Symptoms can include pain in the abdomen, chest, lower back, or groin.

Question 14

What is the Law of Laplace in relation to aortic aneurysms?

Answer 14

It states that the stress in the aneurysm wall is proportional to its diameter, which helps predict rupture potential.

Question 15

What are the induction goals for open aortic surgery?

Answer 15

• Maintain hemodynamic stability
• Avoid extreme fluctuations in blood pressure
• Reduce sympathetic response

Question 16

What is a major complication associated with aortic cross-clamping?

Answer 16

Hypotension below the cross clamp and hypertension above it.

Question 17

What is the effect of aortic cross-clamping on cardiac output?

Answer 17

CO usually decreases depending on left ventricular function.

Question 18

What is the role of spinal drains during thoracoabdominal aortic surgery?

Answer 18

To reduce cerebrospinal fluid (CSF) pressure and optimize spinal cord perfusion pressure.

Question 19

What is the risk of spinal cord injury (SCI) during aortic surgery?

Answer 19

Interruption of blood flow to the arteries supplying the spinal cord, potentially causing ischemia and edema.

Question 20

What should be monitored post-release of the aortic cross-clamp?

Answer 20

Hypotension, metabolic acidosis, and hyperkalemia.

Question 21

What are the types of thoracic aortic aneurysms?

Answer 21

• Ascending aorta
• Arch
• Descending aorta
• Thoracoabdominal aorta

Question 22

What is a common cause of thoracic aortic rupture?

Answer 22

Deceleration injury, such as from a car accident.

Question 23

What are the two types of aortic aneurysms?

Answer 23

• True aneurysms
• False aneurysms

Question 24

What is a potential consequence of unclamping an aortic cross-clamp?

Answer 24

De-clamping shock, characterized by hypotension and redistribution of vascular volume.