CABG 5 Flashcards
WHAT ARE ALL VALVE HEART DISEASE CHARACTERIZED BY?
ABNORMALITIES OF VENTRICULAR LOADING.
WHAT ARE THE GOALS FOR A FAST TRACK CABG?
HOW IS IT DONE?
WHOS A CANIDATE?
WHAT: WEAN FROM VENT IN 4 HRS.
HOW: LIMIT VERSED 1MG/KG OR LESS. FENT < 20 CC. USE PROPOFOL GTT (OR DEXMETETOMIDINE) TO DECREASE NARC REQUIREMENTS. ALSO RELY ON VA.
WHO: MINIMAL HEMODYNAMIC SUPPORT, NO AIRWAY TRAUMA, NO SIG BLEEDING OR ARRYTHMIAS.
WHAT DO YOU DO FOR A BRING BACK CABG?
STILL INTUBATED, FIGURE OUT WHERE YOU CAN GIVE DRUGS! GIVE MR, VERSED, FENT AS BP TOL WITH MINIMAL VA. UNTIL BP OK. GIVE BLOOD PRODUCTS.
WHAT ARE SOME DISADVANTAGES OF BYPASS?
EMBOLIC COMPLICATIONS! THE AORTA IS X CLAMPED.
INFLAMMATORY RESPONSE TO PUMP.
RISK FOR TRANSFUSION. PAIN FROM STERNOTOMY.
PUMP HEAD.
WHAT ARE 2 WAYS OF ISCHEMIC PRECONDITIONING PRIOR TO OFF PUMP PROCEDURE?
OCCLUDE ARTERY FOR 5 MIN FOLLOWED BY REPERFUSION PRIOR TO ANASTOMOSIS.
GIVE 1 MAC ISO PRIOR TO ANASTOMOSIS.
WHAT IS A CRUCIAL INTERVENTION FOR OPCAB? (OFF PUMP CABG)
PRELOAD PT!!! THEY DONT HAVE SUPPORT OF PUMP. OFTEN NEED NEO GTT. MAINTAIN NORMOTHERMIA.
WHATS A MIDCAB? MINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS
BIG PROCEDURE DONE WITH OR WITHOUT PUMP. NEED LOTS OF COMMUNICATION. THORACIC INCISION SO DLT. HIGH RISK OF STROKE.
WHAT IS A DEEP HYPOTHERMIC CIRC ARREST?
FULL CESSATION OF PERFUSION B/C THERES A PROB SO DECREASE CORE TEMP TO 15-20 C….USUALL 20-40 MIN. PROVIDES SURGICAL FIELD WHILE REDUCING THE RISK OF ISCHEMIA.
EFFECTS OF HYPOTHERMIA FROM CIR ARREST
INCREASED PLASMA VISCOSITY/VASOCONSTRICTION….SO YOU WANT HCT 10-20%…DECREASED VISCOSITY IMPROVES MICROCIRCULATION.
DECREASED PLTS. IMPAIRED COAGULATION.
REDUCED GFR.
MET ACIDOSIS. HIGH GLUECOSE.
ANESTHESIA CONSIDERATIONS TO DO CIRC ARREST?
HCT 10-20. REDOSE NMDR. AVOID SHIVERING.
PROP/ETOMIDATE/THIOPENT TO DECREASE CEREBRAL MET AND CBF. STEROID SHOULD BE GIVEN 6-8 HRS PRIOR TO REDCUE INFLAMMATORY RESPONSE.
