Vascular PP2b Flashcards
aortic cross clamp and spinal ischemia
ways to prevent spinal injury
which patients are at increased risk of spinal injury
maintain perfusion, no hypotension, placement of thoracic epidural or lumbar drain
repeat surgeries, long cross clamp time, clamping above the artery of adamkowitz, hypoperfused patients
what are clamp times for TAA and risk of paraplegia
what are additional methods that can help with spinal surgery
less than 30 min = 10% chance of paraplegia
>30min = 90% paraplegia
epidural cooling, placing a GOTT shunt (between ascending and descending aorta )
name (5) things to prevent spinal cord damange w aortic cross clamping
- location of clamp
- duration of clamp
- GOTT shunt
- ICP <12 w lumbar drain or thoracic epidural
- epidural cooling
AOX and bowel ischemia
where are areas of damange (2)
what to watch postop
ischemia oftern occurs to the inferior mesentary and left colon
dont allow hypotension
watch for postop ilieus
AOX and pulmonary complications
%age that have complications
prevention (3)
pulmonary edema from inflammatory markers and reperfusion injury
30% of AAA patients will have pulmonary complications
prevention: low TV, add PEEP and CPAP, add insentive spirometry
stroke and delirum with AOX
which procedures are high risk
prevention with premeds (2)
from emboli that migrate to brain
higher risk with thoracic and AAA repairs
continue to take anti plt drugs, a fib drugs,
TAA: reasons they occur
symptoms
when to have surgery
most 80% are from atherosclerosis, then trauma, aortic dissection and connective tissue disorder (marfans)
tearing pain the chest, back pain, CAD, COPD
AAA > 5.5cm
TAA > 6.5 cm
DAA > 6.0cm
how do we categorizes TAAA
which is the most popular category
Debakey: Type I, II, III
I: ascending aortic tear down entire aorta
II: tear located only in ascending aorta
III: tear is from thoracic to abdominal
Crawford: Type I - IV. type II and III are most difficult to repair. type II at most risk for paraplegia
I: DT and UAA
II: DT and most AA
III: LT and most AA
IV: most AA
Standford: Type A or Type B. Is the ascending aorta involved yes(A) or no (B)
discuss crawford
which are hardest to fix
which is most at risk for paraplegia
Crawford: Type I - IV. type II and III are most difficult to repair. type II at most risk for paraplegia
I: DT and UAA
II: DT and most AA
III: LT and most AA
IV: most AA
Debakey AAA categories
discuss
Debakey: Type I, II, III
I: ascending aortic tear down entire aorta
II: tear located only in ascending aorta
III: tear is from thoracic to abdominal
what are some big risks with AAA and TAA
spinal cord perfusion: artery of adamkowitz and paraplegia
renal perfusion: 30%
pulmonary complications: 50%
overall mortality is 14%
how to prepare of TAA
aline placed where, why
what is a routine procedure
2 large bore IVs, Aline, blood tubing, lots of PRBcs, FFP, platlets (15u)
Aline R radial, proximal to clamp
+- PA cath, CVP pressure
TEE is routine
intraop monitors
add a fem line?
could be measuring SSEP or MEPS
if clamp placed high on descending aorta, want to measure BP to kidneys, other organs, and lower extremety
may use a DLT
TAA induction - emergence
who stays intubated
want smooth, no bucking no coughing, no swings of HTN (aneurysm rupture)
balance anesthesia technique w SSEP or MEP monitoring
extubate in the OR
given alot of blood products, on multiple pressors, clamp time longer than 30 min, pulm edema
why would a TAA patient be coagulopathic after surgery (4)
what are intraop labs for TAA
- hemodilution from blood products
- liver dysfunction from decrease perfusion on clamp time
- hypothermic
- residual heparin in system
ACT, ABG, Glucose, coags, renal labs,
