Anesthetic Management for AAA Flashcards Preview

AP II Final Exam > Anesthetic Management for AAA > Flashcards

Flashcards in Anesthetic Management for AAA Deck (15):
1

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

2

What are 3 noninvasive cardiac evaluations we can perform?

Stress test

Dipyridamole-Thallium Stress test

Dobutamine Stress Echo

3

What are severe cardiac risk factors? (4)

Recent MI
Decompensated heart failure
Significant arrhythmias
Severe valvular disease

4

What are moderate cardiac risk factors? (5)

Ischemic heart disease
Compensated CHF
DM
Renal insufficiency
Cerebrovascular disease

5

What are high risk surgeries? (4)

Emergent surgery
Aortic/major vascular surgery
Peripheral vascular surgery (leg amputation)
Prolonged surgery with large fluid shifts/blood loss

6

What are considered intermediate risk surgeries? (5)

Carotid endarterectomy
Head/neck
Thoracic/Abdominal
Orthopedic
Prostate

7

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.

8

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

9

What type of monitoring is required for AAR (abdominal aortic reconstruction)? (6)

All cases need: 

ASA standard monitors
2 Large bore IVs
Art line

Good LV, need central line

Poor LV, need PA line and TEE

10

Renal effects significant even infrarenally!

What are the renal effects of infrarenal aortic cross clamping?  

decreased renal blood flow

increased renal vascular resistance

reduced GFR

Note: Changes persis for at least 1 hour after unclamping.

11

During thoracic aorta repair, what is at risk of ischemia?

spinal cord, so drain prior to surgery

12

Asymptomatic bruit/stenosis does not increase the stroke risk for general surgery.  True or false?

true

13

What are the neurological risks for carotid endarterectomies? (6)

irregular/ulcerated ipsilateral plaque
thrombus
poor colllaterals
contralateral occlusion
STATINS
history of stroke

14

When is the highest risk of embolism during a carotid endarterectomy? (4)

dissection

shunt insertion

clamp release

12 hours post op

15

What issues can arise after a carotid endarterectomy? (7)

Hyper, hypotension
Carotid body damage
MI
Stroke
Hyperperfusion
Neck hematoma
Cranial nerve injury