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vascular Flashcards

1
Q

most common cause of PVD

A

atherosclerosis

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2
Q

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

A

PVD

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3
Q

end organ involvement PVD

A

diminished pulses, s4 gallop, residual defect from previous stroke

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4
Q

CV decompensation of PVD

A

murmur
JVD
third heart sound
rales
SOB
peripheral edema

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5
Q

Baseline lab studies for vascular surgeries

A

CBC
coags
BMP
biomarkers
12 lead
echo

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6
Q

preop pharm management of patients high risk for MI

A

Beta Blocker 50-60
Statins
Aspirin

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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

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8
Q

periop MI rate for CEA

A

2-5%

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9
Q

where is the most common site of CEA?

A

Bifurcation of the carotid artery & PROXIML internal carotid involvement

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10
Q

Anatomix structures near CEA?

A

RLN & VAGUS
GLOSSOPHARYNGEAL
HYPOGLOSSAL
MANDIBULAR / FACIAL

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11
Q

Chronic HTN shift cerebral autoregulatory curve to thew

A

Right

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12
Q

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

A

BP dependent (about 20%)

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13
Q

Cerebral steal occurs (cerebral vascular dilation) with

A

Hypercarbia –> decreased CBF and increased regional ischemia

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14
Q

Cerebral vasoconstriction occurs with

A

Hypocarbia –> decreased CBF

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15
Q

inhalation effect on CBF

A

increased

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16
Q

anesthetic agents on CMRO2

A

decrease (except ketamine)

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17
Q

Normal Cerebral Blood Flow

A

50ml/100g/min

20ml of oxygen per 100 ml blood

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18
Q

CMRO2

A

3-5ml/100g/min

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19
Q

CPP =

A

MAP - ICP

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20
Q

most common perioperative complication of CEA?

A

MI

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21
Q

How to protect the brain during CEA?

A

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

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22
Q

left shift in the oxyhemoglobin curve

A

extreme hypocarbia

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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

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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

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25
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
Steal phenomenon (or vascular steal) (hypercapnia)
26
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
The Robin Hood phenomenon (also known as the reverse steal phenomenon) (hypocapnia)
27
Protect the brain
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
Blood supply to the brain depends on
Circle of Willis or leptomeningeal pathways (secondary collateral channels that bridge vessels to the sides)
29
cross clamp
common carotid internal " external " maintain map 20% higher than baseline 30min
30
gold standard for identifying neuro deficits in cross clamping
EEG
31
limitation of EEG
effect of BP, temp, and anesthetic effect on EEG only detects superficial laters
32
what vessels perfuse the brain during aortic cross clamp
basilar artery other carotids to circle of Willis
33
stump pressure
gross measurement of the circle of willis pressure < 40 mmHg = hypoperfusion = shunt placement
34
how much heparin before carotid cross clamp and protamine after?
50-100u/kg 50-150 mg
35
CEA local (cervical plexus C2 and C4) or general?
no standard
36
meds not to use during CEA
ketamine nitrous etomidate? Have Cardene on standby
37
most shared post op complication of CEA
hypertension (fluid overload common culprit) often to go pacu on nitro or prusside gtt
38
Sudden bradycardia/hypotension due to surgical stimulation of ____ _____.
carotid sinus
39
treatment of carotid sinus brady/hypotension
1% lidocaine into bifurcation
40
alternative to CEA
angioplasty and stenting
41
FYI about angioplasty
local / min sedation needs to be arousable heparin & ACT >250s brady/hypot reflex
42
Who is angioplasty (CAS) better in?
COPD CHD Valvular heart disease CHF Contralateral heart failure EF Contralateral RLN dysfunction Severe obesity
43
Who is angioplasty (CAS) worse in?
cant take antiplatelet drugs old age >80 severe kidney injury
44
Risk factors for AAA?
50-80 years Male Fam Hx Smoking COPD Caucasion CAD, HTN, PVD, HLD
45
Contraindications to elective repair of AAA
bad angina recent MI bad lungs bad kidneys
46
Aneurysms are defined as those that approach the renal artery origin
Juxtarenal
47
Aneurysms that involve the renal artery origin
Pararenal
48
Law of Laplace
Tension = Pressure x Radius
49
most common reason for poor intraop outcomes in AAA
MI
50
beta blockers for
AAA PVD
51
What is the most important technique for enhancing cardiac function in AAA?
preoperative fluid loading
52
What should urine output be in AAA repair?
1ml/kg/hr
53
How much heparin before the aortic cross-clamp?
100-300 u/kg 5 min before aortic cross-clamping
54
Bloody tap prior to AAA epidural?
cancel surgery
55
4 main AAA goals
keep warm keep HR slow Avoid anemia Prevent HTN
56
Triad of AAA symptoms
1. severe back/abdominal pain 2. AMS d/t hypotension 3. pulsatile abdominal mass
57
What is the most common placement of cross-clamp?
infrarenal
58
central hypervolemia
cross-clamp application
59
central hypovolemia
removal of cross-clamp
60
How does BP change above and below the cross clamp
HTN above HoTN below
61
CO & HR w/ CC
decreases or stays the same Hr unchanged increased venous return
62
decreased with CC
BP below clamp EF CO Renal blood flow total O2 consumption
63
increases w CC
BP above clamp segmental wall motion abnormalities Preload Afterload Contractility LV wall tension Wedge pressure CVP Coronary flow MvO2 Myocardial O2 demand
64

Advanced Anesthesia (8 decks)

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