Cardiac anesthesia Part 2

Question 1

Priority status for heart transplant is given to:

Answer 1

1. ABO compatibility
2. body size match
3. Distance from donor center

Question 2

From retrieval to reimplementation, a heart is good for

Answer 2

4 to 6 hours

Question 3

The typical heart transplant recipient is

Answer 3

NYHA functional class IV with a predicted life expectancy of <12 months. EF <20%

Question 4

The most common indication for heart transplant is

Answer 4

idiopathic cardiomyopathy

Question 5

Contraindications for the recipient to receive a heart transplant include

Answer 5

greater than 70 year old
chronic renal dysfunction
obesity

Question 6

Anesthetic management for heart transplantation is timed so

Answer 6

CPB is initiated when the heart is available

Question 7

Pre op considerations for heart transplantation includes

Answer 7

VAD, IABP, IC, inotropic drug infusions

Question 8

The goal of heart transplantation management is to

Answer 8

go on CPB as fast as possible

Question 9

Induction considerations for heart transplant include

Answer 9

considered full stomach
lines prior to induction
smooth rapid control of airway
slow administration of medications

Question 10

Anesthetic management for heart transplantation includese:

Answer 10

maintain HR & intravascular volume, avoid decrease in SVR

adhere to immunosuppression protocol; high dose steroid & immunosuppressant drug

Question 11

The most common reason for inability to wean from CPB is

Answer 11

right heart failure

Question 12

Drugs that should be available for heart transplantation includes

Answer 12

isoproterenol, epinephrine, phosphodiesterase inhibitors (milrinone), nitric oxide, inhaled prostaglandins

Question 13

________ may be used for heart transplantation to preserve SVR without effect on PVR

Answer 13

Vasopressin

Question 14

After heart transplant, patients may still be prone to

Answer 14

accelerated atherosclerotic disease–> no angina

arrhythmias may be a sign of disease

Question 15

After heart transplant, patients are ________ as a result of _______

Answer 15

volume dependent (preload dependent) as a result of denervation of donor heart during retrieval 
-Frank Starling mechanism still functions

Question 16

Loss of parasympathetic tone post heart transplant results in

Answer 16

faster resting heart rate

-requires direct action on myocardial adrenergic receptors

Question 17

After heart transplant, the CRNA should have

Answer 17

direct acting vasoactive agents, both inotropes and vasoconstrictors available for HR, BP, & CO control

Question 18

Off pump CABG is

Answer 18

immobilization of the heart by compression and/or suction

Question 19

The goal of off pump CABG is to

Answer 19

prevent hypotension and reduced coronary artery perfusion by

• volume load
• head down
• pressors

Question 20

Minimally invasive direct coronary artery bypass is grafting of

Answer 20

single vessel; LIMA to LAD

Question 21

Minimally invasive direct coronary artery bypass includes

Answer 21

lung isolation with double lumen endobronchial tube
off pump case
left anterior thoracotomy incision

Question 22

Procedure notes for mini AVR & MVR procedures include

Answer 22

DLT for lung isolation
femoral cannulation
transvenous pacing- placed and tested
pads on
central venous access

Question 23

The approach for a TAVR/TAVI includes

Answer 23

femoral artery or transapical (apex of left ventricle)

Question 24

Essential components for TAVR/TAVI include:

Answer 24

IV sedation or GETA
large bore IV, art line, central access
TEE or TTE (transthoracic echo)
external defibrillator pads (R2 pads) 
vasopressors

Question 25

Complications of TAVR/TAVI include

Answer 25

strokes cardiac tamponade rupture renal dysfunction

Question 26

Platelet function is lost or altered by

Answer 26

hemodilution, hypothermia, and contact with CPB circuit

Question 27

No single anesthetic "recipe" is suitable for

Answer 27

all patients undergoing coronary artery bypass graft; consider underlying pathology

Question 28

Blood conservation strategies in cardiac surgery include

Answer 28

antifibrinolytic drugs, minimizing hemodilution, cell saver, retrograde priming of pump, normovolemic hemodilution, use of POC testing to support transfusion

Question 29

__________ hemostatic pathway(s) are activated

Answer 29

extrinsic & intrinsic

Question 30

_________ may occur after CBP because of inadequate myocardial protection or inadequate revascularization with resultant right ventricular ischemia

Answer 30

right ventricular dysfunction or failure

Question 31

Numerous clinical approaches have been show to measurably reduce the inflammatory response in cardiac surgical patients including

Answer 31

modification of surgical & perfusion techniques circuit components pharmacologic strategies

Question 32

Even after uncomplicated cardiac surgery, a midline sternotomy (or thoracotomy) causes a significant reduction in

Answer 32

total lung capacity, vital capacity, and forced expiratory volume -will need to use Incentive spirometer

Question 33

CNS insults have decreased to <2% and causes include

Answer 33

micro-emboli cerebral hypoperfusion SIRs

Question 34

The following increase the risk of postop renal dysfunction

Answer 34

renal insufficiency DM type I vascular pathology nephrotoxic agents

Question 35

Randomized trails comparing off-pump CABG with on-pump CABG have

Answer 35

not found convincing or consistent evidence to support one approach over another