Anesthetic Management for Vascular Surgery Flashcards Preview

AP: Cumulative > Anesthetic Management for Vascular Surgery > Flashcards

Flashcards in Anesthetic Management for Vascular Surgery Deck (27):
2

What are 6 significant risk factors for post-op cardiac events?

high risk surgery

ischemic heart disease

creatinine > 2.0

Hx of TIA, CVA

Type I diabetes

Hx of CHF

3

What are 3 noninvasive cardiac evaluations we can perform?

Stress test

Dipyridamole-Thallium Stress test

Dobutamine Stress Echo

4

What are severe cardiac risk factors? (4)

Recent MI
Decompensated heart failure
Significant arrhythmias
Severe valvular disease

5

What are moderate cardiac risk factors? (5)

Ischemic heart disease
Compensated CHF
DM
Renal insufficiency
Cerebrovascular disease

6

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

7

What are considered intermediate risk surgeries? (5)

Carotid endarterectomy
Head/neck
Thoracic/Abdominal
Orthopedic
Prostate

8

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.

9

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

10

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

11

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.

12

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

spinal cord, so drain prior to surgery

ischemia result of thoracic cross clamping

13

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

True

14

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

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

15

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

dissection

shunt insertion

clamp release

12 hours post op

16

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

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

17

what is MET?

Metabolic Equivalent = estimates energy requirements 

1 = basic low level activities

10 = strenuous exercise

18

coronary stent placement has what effect on coagulopathy increasing the risk for this adverse event?

hypercoagulable 

increased risk for MI

19

what drug must be given prior to aortic cross-clamping and why?

heparin (100 U/kg), repeated hourly to prevent thrombosis

20

in order to alter CO2 levels, what must be done when the clamp goes up and then comes back down?

Clamp up = decrease RR

Clamp Down = increase RR

21

What are some differences between Open and Endovascular approaches to AAA repair?

Endo = lower 30 day mortality, less invasive, higher rate of reintervention

22

How do anterior and posterior spinal cord ischemia present differently?

Anterior = impaired motor fxn and temp

Posterior = proprioception & fine motor skills altered 

23

aTAA is at an increased risk of rupture when is is what size?

>6 cm

24

what is the main difference between the carotid sinus and carotid bodies?

carotid sinus = baroreceptor

carotid body = chemoreceptor 

25

List some types of cerebral monitoring that can be used during CEA 

Awake - monitor fxn

EEG - monitor ischemia

SSEP -somatosensory evoked potentials

Oximeter

JvO2

Stump Pressure - pressure above shunt/clamp

TCD - transcranial doppler

26

list 5 physiologic ways to enable cerebral protection

hypertension

hemodilution

hypothermia

normoglycemia

normocarbia

27

what is hyperperfusion syndrome?

vessels maximally dilate distal to stenosis leading to brain edema and hemorrhage

28

what are the risks and symptoms of hyperperfusion syndrome?

Risks:

severe ICA stenosis

uncontrolled HTN

contralateral stenosis

 

Symptoms: 

unilateral headache

seizures

focal signs