AAA: Case Presentation

Question 2

How do you set up the OR for a AAA? (5)

Answer 2

Large ETT

Transducers (double or triple)- Art, Swann, Central lines

Fluid warmers

NG tube

Albumin available?

Question 3

What drugs do you need during a AAA?

Uppers (3)
Downers (3)

Answer 3

Uppers: Norepi, Epi, Vasopressin

Downers: NTG, Nicardipine, Esmolol

Question 4

What does high creatinine indicate?

Answer 4

Renal insufficiency

Question 5

For patients with a pacemaker, what do you need to do?

Answer 5

Need magnet to place on the device.

Question 6

What is the normal diameter of the abdominal aorta?

Answer 6

2-3 cm

Question 7

What do you need to ensure regarding blood prior to surgery?

Answer 7

type and cross

Question 8

What lab value is important because end organ issues can become a major complication during surgery?

Answer 8

Creatinine!

Question 9

What induction drugs do you use for renal/heart patients?

Answer 9

Etomidate 20mg

Fentanyl 250 mcg

Cisatracurium 8mg

Question 10

What are the 3 phases of an AAA?

Answer 10

Dissection

Clamping/Surgical Repair

Unclamping

Question 11

What hemodynamic effects does clamping present?

Answer 11

Increased BP!!

Question 12

What hemodynamic changes does surgical repair present?

Answer 12

Increased BP!

Question 13

PEARL

How do you quickly calculate PaO2?

Answer 13

FiO2 * 5

Question 14

What does clamping do to afterload?

Answer 14

Increases it.

Question 15

During clamping phase, what do you need to do? (2)

Answer 15

Check urine output often to ensure renal perfusion!

Turn off lower body Bair hugger to decrease metabolism/O2 requirement!

Question 16

What is normal urine output?

Answer 16

0.5 - 1.5 cc/kg/hr

Question 17

When clamping, what 2 drugs should be in line?

Answer 17

NTG–reduces preload

Nicardipine

Question 18

What lab value can you expect to change when giving albumin?

Answer 18

Calcium decreases.

Note: Also occurs with cell saver.

Question 19

What does a (-) BE indicate?

Answer 19

Acidic state

Question 20

When unclamping, what should you do? (3)

Answer 20

Take downers out of line!

Pressors in line.

Give fluids– use pressurized bag.

Question 21

What should you do if the pt becomes unstable during unclamping?

Answer 21

Reclamp and reassess.

Question 22

During closing, what should we do? (6)

Answer 22

rewarm;

give protamine (SLOWLY)

check ABG;

fluid & urine status;

call & give ICU report;

BP control for suture lines

Question 23

What are common post-op complications? (7)

Answer 23

MI, arrhythmia (50% of complications)

Renal failure/insufficiency

Ileus

Ventilation problems (TRALI related)

Pain

Bleeding

Multiorgan failure

Question 24

what can be a major complication of AAA surgery?

Answer 24

renal failure

Question 25

what is SIRS and what causes it?

Answer 25

Systemic Inflammatory Response Syndrome

-reperfusion injury: tissue damage when blood returns to previously underperfused areas

Question 26

name 4 factors that can increase the risk of post-op complications

Answer 26

>74 years

> clamp time

emergency status

heart history