What are 6 significant risk factors for post-op cardiac events?
high risk surgery
ischemic heart disease
Creatinine > 2.0
Hx TIA, CVA
Type I diabetes
Hx of CHF
What are 3 noninvasive cardiac evaluations we can perform?
Dipyridamole-Thallium Stress test
Dobutamine Stress Echo
What are severe cardiac risk factors? (4)
Decompensated heart failure
Severe valvular disease
What are moderate cardiac risk factors? (5)
Ischemic heart disease
What are high risk surgeries? (4)
Aortic/major vascular surgery
Peripheral vascular surgery (leg amputation)
Prolonged surgery with large fluid shifts/blood loss
What are considered intermediate risk surgeries? (5)
If functional capacity is < 4 mets and >3 risk factors, do you proceed with intermediate risk surgery?
Yes, with HR control or consider testing if it will change management.
When is CABG indicated? (4)
Stable angina w/ left main stenosis
Stable angina and 3-vessel CAD
Stable angina and 2-vessel CAD with LAD
Unstable angina or acute MI
What type of monitoring is required for AAR (abdominal aortic reconstruction)? (6)
All cases need:
ASA standard monitors
2 Large bore IVs
Good LV, need central line
Poor LV, need PA line and TEE
Renal effects significant even infrarenally!
What are the renal effects of infrarenal aortic cross clamping?
decreased renal blood flow
increased renal vascular resistance
Note: Changes persis for at least 1 hour after unclamping.
During thoracic aorta repair, what is at risk of ischemia?
spinal cord, so drain prior to surgery
Asymptomatic bruit/stenosis does not increase the stroke risk for general surgery. True or false?
What are the neurological risks for carotid endarterectomies? (6)
irregular/ulcerated ipsilateral plaque
history of stroke
When is the highest risk of embolism during a carotid endarterectomy? (4)
12 hours post op
What issues can arise after a carotid endarterectomy? (7)
Carotid body damage
Cranial nerve injury