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NURS 518 > Vascular > Flashcards

Vascular Flashcards

1
Q

Main focus of anesthesia care in vascular surgery is

A

maintain organ perfusion

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2
Q

Greatest cause of morbidity after vascular procedures is injury to the

A

heart

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3
Q

Atherosclerosis compromises

A

blood supply to organs / extremities

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4
Q

Clinical manifestation of Atherosclerosis- 3

A
  • MI
  • Stroke
  • Gagrene
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5
Q

Atherosclerosis occurs in ____ sized arteries

  • What sides?
  • What kind of flow is present in Atherosclerosis?
A
  • medium/large sized arteries
  • branch side
  • turbulent, disrupts laminar flow
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6
Q

Most common sites for Atherosclerosis- 5

A
  • carotid
  • coronary
  • femoral
  • iliac
  • abdominal
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7
Q

Foam cells consist of -2

A

T- Cells & macrophages

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8
Q

Fibroatheromatous plaque consist of- 2

A
  • calcium accumulation

- endothelial integrity is disrupted

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9
Q

Risk factors for Atherosclerosis

A
  • Age
  • Smoking
  • low HDL
  • high LDL
  • HTN
  • Obsity
  • Family hx of CVD
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10
Q

Prevention of Atherosclerosis- 2

A
  • control HTN

- control HLD- statins/ anti-platelets

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11
Q

Which anti-platelet drugs for Atherosclerosis?

A

-plavix & ASA

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12
Q

Statins MOA

A

-inhibit HMG- COa

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13
Q

Most common cause of PVD

A

Atherosclerosis

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14
Q

Signs of PVD

A
  • claudication
  • skin ulceration
  • gangrene
  • impotence
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15
Q

How to approach vascular procedures for last decade- 2

A
  • less invasive procedures

- mdx mgmt

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16
Q

2014 ACC/AHA pre-op CV evaluation guidelines for non-cardiac surgery recommendations- 3

A
  • evaluation
  • mgmt
  • risk of cardiac issues
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17
Q

↑ in myocardial 02 demand- 4

A

-↑ HR, contractility, BP, Diastolic volume

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18
Q

↓ myocardial 02 supply from_____

A
  • ↑HR, diastolic volume

- ↓ coronary blood flow, 02 content, Hct, 02 saturation

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19
Q

Elective surgery should be delayed for ______ after uncomplicated MI

A

4-6 weeks

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20
Q

Delay surgery after stents

  • DES
  • BMS
A
  • DES 1 year

- BMS 1 month

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21
Q

V1, V2

  • affected myocardial area?
  • Which artery(s)?
A

V1, V2

  • affected myocardial area? -septal
  • Which artery(s)? -proximal LAD
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22
Q

V3, V4

  • affected myocardial area?
  • Which artery(s)?
A

V3, V4

  • affected myocardial area? -anterior
  • Which artery(s)? -LAD
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23
Q

V5, V6

  • affected myocardial area?
  • Which artery(s)?
A

V5, V6

  • affected myocardial area?- apical
  • Which artery(s)?- distal LAD, LCX, RCA
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24
Q

I, avL

  • affected myocardial area?
  • Which artery(s)?
A

I, avL

  • affected myocardial area?- lateral
  • Which artery(s)?- Lcx
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25
Q

II, III, avF

  • affected myocardial area?
  • Which artery(s)?
A

II, III, avF

  • affected myocardial area?- inferior
  • Which artery(s)?- RCA
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26
Q

high incidence of COPD due to high incidence of_____

A

smoking

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27
Q

post-op mgmt of patients with pulm. disease- 3

A
  • CPAP
  • incentive spirometer
  • epidural for post-op pain
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28
Q

what is an independent risk factor for post-op cardiac complications?

A

Cr > 2 g/dL

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29
Q

These 2 classes of medications ↓ risk of death in patients with renal impairment

A
  • BB

- Statins

30
Q

Renal ischemia results from (3) during vascular procedures

A
  • cross clamping
  • change in intravascular volume
  • change in CO
31
Q

Keep Hbg > ____ or may lead to _____

A

> 9

-Myocardial Ischemia

32
Q

Monitoring for MI via these 3 modalities

A
  • TEE
  • ECG
  • Pulm artery cath
33
Q

Ischemia > ____ hours can lead to infarction

A

2

34
Q

Surgical stress causing sympathetic stimulation, consider giving____

A

BB

35
Q

Statin current guidelines- recommended for all patients with_____

A

PAD

36
Q

Statins benefit for lower extremity bypass graft?

-Aortic surgery?

A
  • LE bypass– preserve graft patency

- Aortic surgery- preserve renal function

37
Q

which artery do you release to perform allen test

A

radial

38
Q

Take BP in each arm and use the arm with ____ BP

A

highest

39
Q

Abdominal Aortic Aneurysm risk factors- 5

A
  • Male
  • Age
  • smoker
  • family hx
  • Atherosclerotic disease
40
Q

Factors contributing to AAA development -6

A
  • trauma
  • Chronic inflammation
  • Infection
  • marfan
  • syphillis
  • crack/cocaine
41
Q

4 inherited disorders that can lead to aneurysms

A
  • marfan
  • ehlers-danlos
  • bicupid aortic valve
  • non-syndromic familial aortic dissection & aneurysm
42
Q

Surgical repair for AAA indicated if size is > ____

A

6 cm

43
Q

Repair for AAA is warranted if it grows > ___ in ____ time

A

> 0.5 cm in 6 months

44
Q

triad of ruptured AA s/s

A
  • change in LOC
  • severe abdominal/back pain
  • pulsatile abd mass

-other s/s: syncope, hematuria, groin gernia, flank pain

45
Q

2 most common sites for chronic atherosclerosis

A
  • iliac

- infrarenal aorta

46
Q

GOLD STANDARD treatment for aortoiliac occlusive disease

A

aortobifemoral bypass

47
Q

factors involved with aortic cross clamping - 6

A
  • level of clamp
  • blood volume
  • sympathetic NS response
  • Anesthesia technique
  • Anesthesia drugs
  • peri-aortic colaterilazation
48
Q

Above the clamp you will see __?BP

below?

A

above the clamp- HTN

below- HYPOT

49
Q

Physiologic changes with cross-clamping:

  • Segmental wall motion abnormalities
  • LV wall tension
  • EF
  • CO
  • RBF
  • Pulmonary occlusion pressure
  • CVP
  • CI
  • MAP
  • Coronary blood flow
A
  • Segmental wall motion abnormalities ↑
  • LV wall tension ↑
  • EF ↓
  • CO ↓
  • RBF ↓
  • Pulmonary occlusion pressure ↑
  • CVP ↑
  • CI ↓
  • MAP ↑
  • Coronary blood flow ↑
50
Q

Metabolic changes during cross clamping:

  • Oxygen consumption
  • CO2 production
  • mixed venous oxygen saturation
  • Total body oxygen extraction
  • Epi/Norepi release
A
  • Oxygen consumption ↓
  • CO2 production ↓
  • mixed venous oxygen saturation ↑
  • Total body oxygen extraction ↓
  • Epi/Norepi release ↑
51
Q

You will see

resp _____

metabolic ____

during cross-clamping

A

resp alkalosis

met. acidosis

52
Q

Hemodynamic changes with proximal descending thoracic aortic cross-clamping

A

↑ MAP, CVP, Pulm artery pressure

↓ CI

53
Q

changes to superceliac aorta with cross-clamping

A

↓ EF

↑ MAP, Pulm. pressures, left ventricular pressures, wall abnormalities leading to ischemia.

54
Q

What’s one result of thoracic aortic cross clamping?

A

50% ↓ 02 consumption

55
Q

T/F?

-thoracic epidural and adequate urine output can prevent/indicate post-op renal failure?

A

false

56
Q

Clamping above renal arteries, blood flow reduced by:

A

83-90%

57
Q

clamping below renal arteries, blood flow reduced by:

A

38%

58
Q

best indicator for post-op renal failure?

most common cause of post-op renal dysfunction

A

pre-op renal dysfunction

Acute tubular necrosis

59
Q

Benefits of Mannitol on kidneys? 4

A
  • improve blood flow
  • removes free radicals
  • decreases renin release
  • decrease endothelial edema
60
Q

bad effect of dopamine

A

-Tachycardia- ↑02 consumption

61
Q

what is released during unclamping?

A

Cardiodepressants

  • lactic acid
  • 02 free radicals
  • neutrophils
62
Q

Changes with aortic unclamping:

  • contractility
  • BP
  • Pulm artery pressure
  • CVP
  • Venous return
  • CO
A

“everything is stuck on left side”

  • contractility ↓
  • BP ↓
  • Pulm artery pressure ↑
  • CVP ↓
  • Venous return ↓
  • CO ↓
63
Q

Metabolic changes with unclamping

  • Total body oxygenation consumption
  • lactate
  • mixed venous oxygenation saturation
  • prostaglandins
  • activated complement
  • Myocardial depressant factors
  • Temp
A
  • Total body oxygenation consumption ↑
  • lactate ↑
  • mixed venous oxygenation saturation ↓
  • prostaglandins ↑
  • activated complement ↑
  • Myocardial depressant factors ↑
  • Temp ↓
64
Q

clamping of this part of aorta can lead to spinal cord ischemia

A

thoracic

65
Q

__#___ anterior spinal artery

____ posterior

A

1 anterior

2 posterior

66
Q

Anesthetic plan for induction for patients undergoing aortic surgery

A
  • maintain hemodynamics
  • normothermia
  • can use thoracic epidurals
67
Q

Superceliac aortic cross-clamp > 30 mins…..emergence plan?

A

leave intubated

68
Q

sign of thoracic aneurysm

A

back pain

69
Q

What kind of aneurysm?

  • majority descending and upper abdominal
  • majority descending and majority abdominal
  • lower descending and most abdominal
  • mostly abdominal
A

I
II
III
IV

70
Q

Debakey I vs II vs III

A

I- begins in ascending aorta and involes entire aorta

II- ascending aorta

III- after subclavian

71
Q

most common complication of open surgical repair? other 2?

A

pulmonary 50%

Gi

Renal

72
Q

benefits to endovascular approach

A
  • less clamp time
  • less blood loss
  • faster recovery
  • small incision

NURS 518 (1 decks)

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