Anesthesia for aortic procedures and other vascular procedures

Question 1

Biggest risk factors for vascular disease

Answer 1

1. smoking
2. diabetes

Question 2

mortality rate in patients with vascular disease compared to gen pop

Answer 2

2-6 times greater than gen pop

Question 3

AAA risk factors

Answer 3

age
smoking
increased height

elective AAA is most frequent vascular surgical procedure

Question 4

Surgical intervention of AAA is indicated when

Answer 4

> 0.5cm increase in less than 6 months or symptomatic patients and 5.0 cm or greater

Question 5

important equipment for AAA

Answer 5

1. Foley (monitor for kidney hypoperfusion)
2. vasoactive gtts
3. blood tubing and blood
4. SSEP or MEP for ischemia monitoring
5. air wamring device

Question 6

AAA BP and HR monitoring goals

what do you want for BP and HR?

Answer 6

1. BP within 20% of baseline
2. HR conrolled avoid tachycardia

Question 7

Why is renal preservation so important? (AAA) - think of clamping causing kidney ischemia

Answer 7

mortality rate is 4-5 times higher in pts that develop AKI

Question 8

Urine output should be (AAA)

Answer 8

0.5-1.0 mL/Kg/hr

Question 9

the best assessment of fluid status is via

Answer 9

TEE

need to keep pt hydrated

Question 10

Clamp causes (strain)

Answer 10

Acute left ventricular strain

Question 11

BP above clamp is

Answer 11

hypertension

Question 12

BP below clamp is

Answer 12

hypotensino

Question 13

Spinal cord ischemia during AAA clamp

Answer 13

interruption of blood flow to greater radicular artery (artery of Adamkeiwicz)

can cause paraplegia

Question 14

Ways to reduce risk of spinal cord ischemia

Answer 14

SSEP/MEP
short clamp time
higher perfusino pressures
CSF drainange

Question 15

AAA incidence of renal dysfucntion

Answer 15

10-20%

Question 16

MAP should be ____ to decrease risk of renal dysfunction in AAA

Answer 16

MAP of 60 or greater is warranted

and decreased clamp time

Question 17

AAA unclamping

Answer 17

prepare for hypotension

Question 18

AAA rupture classic triad

Answer 18

becks triad:
1. hypotension
3. back pain
3. abdominal pulsatile mass

Question 19

for a dissecting AAA,what should you have and anesthetic considerations

Answer 19

have blood
2 large IVS
art line
RSI/full stomach prepared

Question 20

Resection of ascending aorta and graft replacement will need (thoracic AAA)

Answer 20

CPB

Question 21

most commone aortic aneurysm repaire

Answer 21

endovascular

Question 22

PVD risk factores

Answer 22

age
HTN
tobacco
diabetes family history

Question 23

Renal artery stenosis

what is it?
what happens as a result?
S/sx
What is usually the cause?

Answer 23

usually caused by atherosclerosis

causes activation of renin-angiotensin system = vasoconstriction, sodium retention, hypertension

Question 24

Aortoiliac occlusive disesae

what is it, what happens

Answer 24

circulatory problems in the lower extremities, claudication

s/sx: diminishd/absent pedal pulses, decreased capillary refill

Question 25

Visceral artery stenosis what is it, who is at risk? What most often causes it?

Answer 25

causes "intestinal angina" = weight loss more common in women* often from athersclerosis

Question 26

Takayasu's arteritis what is it? who is at risk? What does it usually affect?

Answer 26

progressive occlusive vasculitis of LARGE VESSELS Asian women <40 years usually affects aorta + branches

Question 27

Takyasu's arteritis anesthetc considerations

Answer 27

1. caution with head extension* 2. seteroid therapy 3. anticoagulation 4. positioning 5. keep BP normal or slightly eleveated

Question 28

Tromboangiitis abliterans aka

Answer 28

Buerger's disease

Question 29

Thromboangiitis Obliterans/ Buerger's disease what is it? what is it associated with as a risk factor?

Answer 29

Occlusion of medium and small vessels of extremities usually associated with tobacco use

Question 30

Wegners granulomatosis what is it and what is it associated with

Answer 30

Necrotizing granulomas in inflamed vessels Pts are usually on chronic steroids can be in airway!

Question 31

Wegner's important anesthetic consideration

Answer 31

can be in airway and cause airway narrowing multiple organ involvement

Question 32

Temporal arteritis what is it, treatment, anesthesia considerations

Answer 32

inflammation of arteries in head and neck Treatment: corticosteroids anesthetic considerations: Steroids, careful positioning

Question 33

Polyarteritis Nodosa What is it? Where is it usually and where else could it be? What is it associated with as a possible risk factor?

Answer 33

Vasculitis involving small and medium sized arteries especially kidneys associated with Hep B infection

Question 34

Polyarteritis Nodosa anesthetic considerations

Answer 34

-Consider renal or cardiac involvement -pt may be on steroids -HTN usually present

Question 35

Henoch-Schonlein Purpura what is it, who/when does it occur

Answer 35

Inflammation of the arterioles and capillaries of the skin, kidneys, GI tract, large joints common in kids, especially following a respiratory infection

Question 36

Kawasaki disease what is it, who gets it,

Answer 36

Vasculitis involvement of coronary arteries Occurs in kids, believed to be caused by a non-contagious infections

Question 37

Raynaud phenomenon anesthetic considerations

Answer 37

Episodic vasospastic ischemia of the digits considerations: -careful with vasoconstrictors (phenyl) -Keep warm (triggered by cold) -careful positioning

Question 38

Moyamoya disease who gets it and what happens

Answer 38

Rare, progressive disease of kids and young adults occlusion of internal carotid, middle and anterior

Question 39

Moyamoya anesthesia consideration

Answer 39

1. preserve CBF 2. keep them deep 3. Keep BP in tight range

Question 40

Klippel-Trenaunay-Weber syndrome what is it, anesthetic considerations

Answer 40

"Local gigantism" venous malformations of extremities, neck, trunk Anesthetic considerations: No neuraxial blockade due to spinal AVMs

Question 41

Bechet's disease what is it, treatment, anesthesia consideration

Answer 41

Relapsing inflammatory disorder causing oral, genital, and GI ulcers and uveitis tx: steroids consideratsions: -positioning -steroid stress dose -neuro exam

Question 42

AV fistula formation how do we do it? What is necessary? Anesthetic considerations

Answer 42

Upper extremity vessels Use 5000-8000 units of heparin anesthetic consideration: can usually be performed under MAC/regional