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Principles semester 2 > Anesthesia for cardiac surgery > Flashcards

Anesthesia for cardiac surgery Flashcards

1
Q

Goals of cardiac surgery

A

optimizing myocardial supply and demand are the goals of the surgery

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2
Q

Gold standard for diagnosis of cardiac pathology

A

heart cath results

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3
Q

Place art line

A

in pre op or or PRIOR TO INDUCTION

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4
Q

Subclavian vein depth

A

10 cm

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5
Q

Right EJ depth

A

10 -15 cm

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6
Q

Right IJ depth

A

15-20 cm

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7
Q

Femoral depth

A

35-40 cm

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8
Q

RAC depth

A

40 cm

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9
Q

LAC deph

A

50 cm

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10
Q

Most sensitive clinica monitor for detection wall motion abnormalities

A

TEE

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11
Q

Heparin cardiac surgery setup

A

400-400 units/kg ready but not drawn up

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12
Q

High stimulation pre-bypass times

A
  1. incision
  2. sternotomy
  3. sympathetic nerve dissection and opening of pericardium
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13
Q

Low stimulation pre bypas times

A

Harvesting

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14
Q

ACT should be checked

A

3 min after heparinA

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15
Q

ACT for bypass should be

A

greater than 400

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16
Q

Aortic canulation BP

A

SBP needs to be 100-90 mmHG
or
MAP < 70

to prevent dissection

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17
Q

RAP

A

retrorade autologous priming

causes hypotension, blood pressure will need to be elevated

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18
Q

On bypass, ACT should be

A

> 400-450

19
Q

CPB is iniated when

A

perfusionists release the clamp that occludes the tubing connectin the venous cannula to the venous reservoir

20
Q

arterial filter pore size (CPB)

A

21-40um

21
Q

Cardioplegia role and active ingredient

A

stops myocardial contraction

primary active ingredient: potassium chloride

22
Q

Components of Cardioplegia

A
  1. KCL 10-40 mEq/L
  2. Sodium <140 mEq/L
  3. Calcium chloride (cellular integrity)
  4. bicarb (metabolic buffer)
  5. mag sulfate (regulates Ca influx, antiarrhythimic)
  6. glucose, insulin, glutamate
    Maybe:
  7. nitroglycerin, mannitol, lidocaine
23
Q

Methods of cardoplegia (3)

A
  1. antegrade (aortic root)
  2. down each vein graft (after distal anastamosis)
  3. retrograde (coronary sinus)
24
Q

body temp cooled to (CPB)

A

20-32 deg c

25
Q

Deep hypothermia with circulatory arrest indication and temp

A
  1. complex intra cardiac defects
  2. aortic arch
  3. some cranial surgeries

<18 deg C

26
Q

Deep hypothermia max time

A

60 minutes

27
Q

Deep hypothermia temp monitoring sites

A
  1. nasopharynx/brainstem temp (anesthesia)
  2. bladder via foley (perfusionist)
28
Q

Cooling adjunts for brain protection

A
  1. pack head on ice
  2. high dose hypnotics for isoelectric EEG
  3. cellular membrane stabilization (steroids, free radical scavengers)
29
Q

How to prevent myocardial injury

A

preven arrhythmias or treat ASAP

30
Q

Cardiac arrythmias cause

A

increased demand and decreased oxygen supply

31
Q

Protamine role

A

neutralizes heparin

32
Q

Test dose of protamine

A

10 mg, watch for anaphylaxis

33
Q

Protamine can cause

A

profound hypotension. give SLOWLY via peripheral line if possible

34
Q

protamine dose should not be given if

A

cannula is stil in place

35
Q

protamine dose

A

1 mg for every 100 units of heparin given

36
Q

draw ACT ____ after protamine

A

3 minutes

37
Q

Aortic stenosis is considered severe when diameter is

A

0.7 cm sq or less

38
Q

most common valve lesion in industrialized countries

A

aortic stenosis

39
Q

most commone MR complication

A

a fib (50% of patients with MR have atrial fibrillation)

40
Q

Cautery that interefere with pacemaker

A

occurs with unipolar, rare in bipolar

41
Q

pacemaker should not be between

A

cautery pad and surgical site

42
Q

Meds that interfere with pacemaker:

A
  1. succinylcholine
  2. etomidate
43
Q
A

Principles semester 2 (17 decks)

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