1
Q
Main focus of anesthesia care in vascular surgery is
A
maintain organ perfusion
2
Q
Greatest cause of morbidity after vascular procedures is injury to the
A
heart
3
Q
Atherosclerosis compromises
A
blood supply to organs / extremities
4
Q
Clinical manifestation of Atherosclerosis- 3
A
- MI
- Stroke
- Gagrene
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
6
Q
Most common sites for Atherosclerosis- 5
A
- carotid
- coronary
- femoral
- iliac
- abdominal
7
Q
Foam cells consist of -2
A
T- Cells & macrophages
8
Q
Fibroatheromatous plaque consist of- 2
A
- calcium accumulation
- endothelial integrity is disrupted
9
Q
Risk factors for Atherosclerosis
A
- Age
- Smoking
- low HDL
- high LDL
- HTN
- Obsity
- Family hx of CVD
10
Q
Prevention of Atherosclerosis- 2
A
- control HTN
- control HLD- statins/ anti-platelets
11
Q
Which anti-platelet drugs for Atherosclerosis?
A
-plavix & ASA
12
Q
Statins MOA
A
-inhibit HMG- COa
13
Q
Most common cause of PVD
A
Atherosclerosis
14
Q
Signs of PVD
A
- claudication
- skin ulceration
- gangrene
- impotence
15
Q
How to approach vascular procedures for last decade- 2
A
- less invasive procedures
- mdx mgmt
16
Q
2014 ACC/AHA pre-op CV evaluation guidelines for non-cardiac surgery recommendations- 3
A
- evaluation
- mgmt
- risk of cardiac issues
17
Q
↑ in myocardial 02 demand- 4
A
-↑ HR, contractility, BP, Diastolic volume
18
Q
↓ myocardial 02 supply from_____
A
- ↑HR, diastolic volume
- ↓ coronary blood flow, 02 content, Hct, 02 saturation
19
Q
Elective surgery should be delayed for ______ after uncomplicated MI
A
4-6 weeks
20
Q
Delay surgery after stents
- DES
- BMS
A
- DES 1 year
- BMS 1 month
21
Q
V1, V2
- affected myocardial area?
- Which artery(s)?
A
V1, V2
- affected myocardial area? -septal
- Which artery(s)? -proximal LAD
22
Q
V3, V4
- affected myocardial area?
- Which artery(s)?
A
V3, V4
- affected myocardial area? -anterior
- Which artery(s)? -LAD
23
Q
V5, V6
- affected myocardial area?
- Which artery(s)?
A
V5, V6
- affected myocardial area?- apical
- Which artery(s)?- distal LAD, LCX, RCA
24
Q
I, avL
- affected myocardial area?
- Which artery(s)?
A
I, avL
- affected myocardial area?- lateral
- Which artery(s)?- Lcx
25
II, III, avF
- affected myocardial area?
- Which artery(s)?
II, III, avF
- affected myocardial area?- inferior
- Which artery(s)?- RCA
26
high incidence of COPD due to high incidence of_____
smoking
27
post-op mgmt of patients with pulm. disease- 3
- CPAP
- incentive spirometer
- epidural for post-op pain
28
what is an independent risk factor for post-op cardiac complications?
Cr > 2 g/dL
29
These 2 classes of medications ↓ risk of death in patients with renal impairment
- BB
| - Statins
30
Renal ischemia results from (3) during vascular procedures
- cross clamping
- change in intravascular volume
- change in CO
31
Keep Hbg > ____ or may lead to _____
> 9
-Myocardial Ischemia
32
Monitoring for MI via these 3 modalities
- TEE
- ECG
- Pulm artery cath
33
Ischemia > ____ hours can lead to infarction
2
34
Surgical stress causing sympathetic stimulation, consider giving____
BB
35
Statin current guidelines- recommended for all patients with_____
PAD
36
Statins benefit for lower extremity bypass graft?
-Aortic surgery?
- LE bypass-- preserve graft patency
| - Aortic surgery- preserve renal function
37
which artery do you release to perform allen test
radial
38
Take BP in each arm and use the arm with ____ BP
highest
39
Abdominal Aortic Aneurysm risk factors- 5
- Male
- Age
- smoker
- family hx
- Atherosclerotic disease
40
Factors contributing to AAA development -6
- trauma
- Chronic inflammation
- Infection
- marfan
- syphillis
- crack/cocaine
41
4 inherited disorders that can lead to aneurysms
- marfan
- ehlers-danlos
- bicupid aortic valve
- non-syndromic familial aortic dissection & aneurysm
42
Surgical repair for AAA indicated if size is > ____
6 cm
43
Repair for AAA is warranted if it grows > ___ in ____ time
> 0.5 cm in 6 months
44
triad of ruptured AA s/s
- change in LOC
- severe abdominal/back pain
- pulsatile abd mass
-other s/s: syncope, hematuria, groin gernia, flank pain
45
2 most common sites for chronic atherosclerosis
- iliac
| - infrarenal aorta
46
GOLD STANDARD treatment for aortoiliac occlusive disease
aortobifemoral bypass
47
factors involved with aortic cross clamping - 6
- level of clamp
- blood volume
- sympathetic NS response
- Anesthesia technique
- Anesthesia drugs
- peri-aortic colaterilazation
48
Above the clamp you will see __?BP
below?
above the clamp- HTN
below- HYPOT
49
Physiologic changes with cross-clamping:
- Segmental wall motion abnormalities
- LV wall tension
- EF
- CO
- RBF
- Pulmonary occlusion pressure
- CVP
- CI
- MAP
- Coronary blood flow
- Segmental wall motion abnormalities ↑
- LV wall tension ↑
- EF ↓
- CO ↓
- RBF ↓
- Pulmonary occlusion pressure ↑
- CVP ↑
- CI ↓
- MAP ↑
- Coronary blood flow ↑
50
Metabolic changes during cross clamping:
- Oxygen consumption
- CO2 production
- mixed venous oxygen saturation
- Total body oxygen extraction
- Epi/Norepi release
- Oxygen consumption ↓
- CO2 production ↓
- mixed venous oxygen saturation ↑
- Total body oxygen extraction ↓
- Epi/Norepi release ↑
51
You will see
resp _____
metabolic ____
during cross-clamping
resp alkalosis
met. acidosis
52
Hemodynamic changes with proximal descending thoracic aortic cross-clamping
↑ MAP, CVP, Pulm artery pressure
| ↓ CI
53
changes to superceliac aorta with cross-clamping
↓ EF
| ↑ MAP, Pulm. pressures, left ventricular pressures, wall abnormalities leading to ischemia.
54
What's one result of thoracic aortic cross clamping?
50% ↓ 02 consumption
55
T/F?
-thoracic epidural and adequate urine output can prevent/indicate post-op renal failure?
false
56
Clamping above renal arteries, blood flow reduced by:
83-90%
57
clamping below renal arteries, blood flow reduced by:
38%
58
best indicator for post-op renal failure?
most common cause of post-op renal dysfunction
pre-op renal dysfunction
Acute tubular necrosis
59
Benefits of Mannitol on kidneys? 4
- improve blood flow
- removes free radicals
- decreases renin release
- decrease endothelial edema
60
bad effect of dopamine
-Tachycardia- ↑02 consumption
61
what is released during unclamping?
Cardiodepressants
- lactic acid
- 02 free radicals
- neutrophils
62
Changes with aortic unclamping:
- contractility
- BP
- Pulm artery pressure
- CVP
- Venous return
- CO
"everything is stuck on left side"
- contractility ↓
- BP ↓
- Pulm artery pressure ↑
- CVP ↓
- Venous return ↓
- CO ↓
63
Metabolic changes with unclamping
- Total body oxygenation consumption
- lactate
- mixed venous oxygenation saturation
- prostaglandins
- activated complement
- Myocardial depressant factors
- Temp
- Total body oxygenation consumption ↑
- lactate ↑
- mixed venous oxygenation saturation ↓
- prostaglandins ↑
- activated complement ↑
- Myocardial depressant factors ↑
- Temp ↓
64
clamping of this part of aorta can lead to spinal cord ischemia
thoracic
65
__#___ anterior spinal artery
____ posterior
1 anterior
2 posterior
66
Anesthetic plan for induction for patients undergoing aortic surgery
- maintain hemodynamics
- normothermia
- can use thoracic epidurals
67
Superceliac aortic cross-clamp > 30 mins.....emergence plan?
leave intubated
68
sign of thoracic aneurysm
back pain
69
What kind of aneurysm?
- majority descending and upper abdominal
- majority descending and majority abdominal
- lower descending and most abdominal
- mostly abdominal
I
II
III
IV
70
Debakey I vs II vs III
I- begins in ascending aorta and involes entire aorta
II- ascending aorta
III- after subclavian
71
most common complication of open surgical repair? other 2?
pulmonary 50%
Gi
Renal
72
benefits to endovascular approach
- less clamp time
- less blood loss
- faster recovery
- small incision
NURS 518
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