Thoracic Aneurysm

Question 1

what is the DeBakey classification for aortic dissection?

Answer 1

Type 1: originates ascending aorta –> descending aorta

Type 2: originate ascending aorta –> don’t go beyond innominate

Type 3: originate beyond L subclavian artery –> distally tp diaphragm (3a) or aorto-iliac bifurcation (3b)

if it involves the ascending aorta it’s an emergency

Question 2

what is the Stanford classification of aortic dissection?”

Answer 2

Type A: involves ascending aorta

Type B: descending aorta only (ascending not involved)

Question 3

What PFT findings suggest increased risk of post-op mechanical ventilation?

Answer 3

FEV1 < 2L total
Max breathing capacity < 50% predicted
Maximal Mid-Expiratory Flow Rate (MMEFR) < 50% predicted

Question 4

Would you place lumbar drain in thoracic aneurysm case? What would you keep CSF pressure to?

Answer 4

passive drainage of CSF to 8-10mmHg

preserved spinal cord perfusion

Question 5

What is Acute Normovolemic Hemodilution (ANH)?

Answer 5

• Need initial Hct > 33% and Hgb > 11 g/dL
• autologous blood collected at beginning or case prior to hemodilution, re-infused when significant bleeding has been controlled
• moderate benefit, saves 1-2 units of PRBC

Question 6

what temp probe locations given estimate of core body temperature?

Answer 6

bladder
nasopharynx
distal esophagus
tympanic membrane 
pulmonary artery

Question 7

where would you place art line for thoracic aneursym surgery?

Answer 7

hyperT above clamp, hypoT below
place proximal and distal art lines
may clamp L subclavian artery during procedure
place art line in R arm and lower extremity