Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced Anesthesia > vascular > Flashcards

vascular Flashcards

1
Q

most common cause of PVD

A

atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Primary risk factors for MI, stroke, chronic mesenteric ischemia, renovascular HTN, and extremist aneurysm:

A

PVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

end organ involvement PVD

A

diminished pulses, s4 gallop, residual defect from previous stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

CV decompensation of PVD

A

murmur
JVD
third heart sound
rales
SOB
peripheral edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Baseline lab studies for vascular surgeries

A

CBC
coags
BMP
biomarkers
12 lead
echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

preop pharm management of patients high risk for MI

A

Beta Blocker 50-60
Statins
Aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Carotid Endarterectomy indication

A

TIA w/ >70% stenosis
severe ipsilateral stenosis in pt w stroke
30-70% occlusion w/ ipsilateral symptoms

Asymptomatic are stented

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

periop MI rate for CEA

A

2-5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

where is the most common site of CEA?

A

Bifurcation of the carotid artery & PROXIML internal carotid involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Anatomix structures near CEA?

A

RLN & VAGUS
GLOSSOPHARYNGEAL
HYPOGLOSSAL
MANDIBULAR / FACIAL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Chronic HTN shift cerebral autoregulatory curve to thew

A

Right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

The right shift in autoregulatory curve –> Higher than normal MAP required & causes CBF to become

A

BP dependent (about 20%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cerebral steal occurs (cerebral vascular dilation) with

A

Hypercarbia –> decreased CBF and increased regional ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cerebral vasoconstriction occurs with

A

Hypocarbia –> decreased CBF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

inhalation effect on CBF

A

increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

anesthetic agents on CMRO2

A

decrease (except ketamine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Normal Cerebral Blood Flow

A

50ml/100g/min

20ml of oxygen per 100 ml blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CMRO2

A

3-5ml/100g/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

CPP =

A

MAP - ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

most common perioperative complication of CEA?

A

MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How to protect the brain during CEA?

A

normocarbia (PaCO2 35-44) (EtCO2 gradient (lower) >5mm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

left shift in the oxyhemoglobin curve

A

extreme hypocarbia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is abolished in the area surrounding an acute cerebral infarction due to loss of BV reactivity d/t acid products?

A

autoregulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Refers to a condition in which there is an increased blood flow to a particular region of tissue, often after an initial period of reduced blood supply (ischemia).

A

luxury perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Occurs when blood flow is diverted away from a particular region of the body due to changes in the circulatory system. This often happens when there is a blockage in a major artery, and as a result, blood is “stolen” from one area to supply another region with higher demands. This can occur in the brain, heart, or other organs and may result in ischemia (reduced blood flow) in the area that is deprived of blood

A

Steal phenomenon (or vascular steal)

(hypercapnia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Refers to a situation in which blood flow is redistributed from areas of the brain that are less ischemic (suffering from reduced blood flow) to more ischemic areas, potentially improving blood supply to the more critically affected regions

A

The Robin Hood phenomenon (also known as the reverse steal phenomenon)

(hypocapnia)

27
Q

Protect the brain

A

Hypothermia (controversial)
Glucose control (avoid glucose fluid)
Anesthetics drop CMRO2 in the brain
hemodilution
normocarbia
tight BP control
anestherics have cerebral protective properties

use a shunt or decrease CMRO2

28
Q

Blood supply to the brain depends on

A

Circle of Willis or leptomeningeal pathways (secondary collateral channels that bridge vessels to the sides)

29
Q

cross clamp

A

common carotid
internal “
external “

maintain map 20% higher than baseline
30min

30
Q

gold standard for identifying neuro deficits in cross clamping

A

EEG

31
Q

limitation of EEG

A

effect of BP, temp, and anesthetic effect on EEG
only detects superficial laters

32
Q

what vessels perfuse the brain during aortic cross clamp

A

basilar artery
other carotids
to circle of Willis

33
Q

stump pressure

A

gross measurement of the circle of willis pressure
< 40 mmHg = hypoperfusion = shunt placement

34
Q

how much heparin before carotid cross clamp and protamine after?

A

50-100u/kg

50-150 mg

35
Q

CEA local (cervical plexus C2 and C4) or general?

A

no standard

36
Q

meds not to use during CEA

A

ketamine
nitrous
etomidate?

Have Cardene on standby

37
Q

most shared post op complication of CEA

A

hypertension (fluid overload common culprit)

often to go pacu on nitro or prusside gtt

38
Q

Sudden bradycardia/hypotension due to surgical stimulation of ____ _____.

A

carotid sinus

39
Q

treatment of carotid sinus brady/hypotension

A

1% lidocaine into bifurcation

40
Q

alternative to CEA

A

angioplasty and stenting

41
Q

FYI about angioplasty

A

local / min sedation
needs to be arousable
heparin & ACT >250s
brady/hypot reflex

42
Q

Who is angioplasty (CAS) better in?

A

COPD
CHD
Valvular heart disease
CHF
Contralateral heart failure EF
Contralateral RLN dysfunction
Severe obesity

43
Q

Who is angioplasty (CAS) worse in?

A

cant take antiplatelet drugs
old age >80
severe kidney injury

44
Q

Risk factors for AAA?

A

50-80 years
Male
Fam Hx
Smoking
COPD
Caucasion
CAD, HTN, PVD, HLD

45
Q

Contraindications to elective repair of AAA

A

bad angina
recent MI
bad lungs
bad kidneys

46
Q

Aneurysms are defined as those that approach the renal artery origin

A

Juxtarenal

47
Q

Aneurysms that involve the renal artery origin

A

Pararenal

48
Q

Law of Laplace

A

Tension = Pressure x Radius

49
Q

most common reason for poor intraop outcomes in AAA

A

MI

50
Q

beta blockers for

A

AAA
PVD

51
Q

What is the most important technique for enhancing cardiac function in AAA?

A

preoperative fluid loading

52
Q

What should urine output be in AAA repair?

A

1ml/kg/hr

53
Q

How much heparin before the aortic cross-clamp?

A

100-300 u/kg 5 min before aortic cross-clamping

54
Q

Bloody tap prior to AAA epidural?

A

cancel surgery

55
Q

4 main AAA goals

A

keep warm
keep HR slow
Avoid anemia
Prevent HTN

56
Q

Triad of AAA symptoms

A
  1. severe back/abdominal pain
  2. AMS d/t hypotension
  3. pulsatile abdominal mass
57
Q

What is the most common placement of cross-clamp?

A

infrarenal

58
Q

central hypervolemia

A

cross-clamp application

59
Q

central hypovolemia

A

removal of cross-clamp

60
Q

How does BP change above and below the cross clamp

A

HTN above
HoTN below

61
Q

CO & HR w/ CC

A

decreases or stays the same
Hr unchanged
increased venous return

62
Q

decreased with CC

A

BP below clamp
EF
CO
Renal blood flow
total O2 consumption

63
Q

increases w CC

A

BP above clamp
segmental wall motion abnormalities
Preload
Afterload
Contractility
LV wall tension
Wedge pressure
CVP
Coronary flow
MvO2
Myocardial O2 demand

64
Q
A

Advanced Anesthesia (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions