How do you set up the OR for a AAA? (5)
Transducers (double or triple)- Art, Swann, Central lines
What drugs do you need during a AAA?
Uppers: Norepi, Epi, Vasopressin
Downers: NTG, Nicardipine, Esmolol
What does high creatinine indicate?
For patients with a pacemaker, what do you need to do?
Need magnet to place on the device.
What is the normal diameter of the abdominal aorta?
What do you need to ensure regarding blood prior to surgery?
type and cross
What lab value is important because end organ issues can become a major complication during surgery?
What induction drugs do you use for renal/heart patients?
Fentanyl 250 mcg
What are the 3 phases of an AAA?
What hemodynamic effects does clamping present?
What hemodynamic changes does surgical repair present?
How do you quickly calculate PaO2?
FiO2 * 5
What does clamping do to afterload?
During clamping phase, what do you need to do? (2)
Check urine output often to ensure renal perfusion!
Turn off lower body Bair hugger to decrease metabolism/O2 requirement!
What is normal urine output?
0.5 - 1.5 cc/kg/hr
When clamping, what 2 drugs should be in line?
What lab value can you expect to change when giving albumin?
Note: Also occurs with cell saver.
What does a (-) BE indicate?
When unclamping, what should you do? (3)
Take downers out of line!
Pressors in line.
Give fluids-- use pressurized bag.
What should you do if the pt becomes unstable during unclamping?
Reclamp and reassess.
During closing, what should we do? (6)
give protamine (SLOWLY)
fluid & urine status;
call & give ICU report;
BP control for suture lines
What are common post-op complications? (7)
MI, arrhythmia (50% of complications)
Ventilation problems (TRALI related)
what can be a major complication of AAA surgery?
what is SIRS and what causes it?
Systemic Inflammatory Response Syndrome
-reperfusion injury: tissue damage when blood returns to previously underperfused areas
name 4 factors that can increase the risk of post-op complications
> clamp time