Cardiovascular anesthesia

Question 1

retrograde autologus priming uses

Answer 1

pt blood to displace crystalloid primed pump tubing

Question 2

when full flow on pump is confirmed, you should

Answer 2

turn vent to bag and monitor to bypass mode. Sevo off

Question 3

Most difficult crawford aneurysms to remair

Answer 3

1 and 2

Question 4

Crawford 2 aneurysm has significant risk for

Answer 4

paraplegia and renal failure

artery of adamkiewicz

Question 5

Which dissection is a surgical emergency

Answer 5

acute dissection of ascending aorta

often includes aortic valve

Question 6

which dissection is usually medically manaanged

Answer 6

descending aorta (unless ruptured or leaking)

Question 7

Classic AAA triad

Answer 7

1. hypotension
2. back pain
3. Pulsatile abdominal mass

Question 8

higher clamp generally means

Answer 8

greater insult

Question 9

how many posterior spinal arteries are there and what is perfused

Answer 9

2 posterior spinal arteries perfuse posterior 1/3 of the spinal cord

Question 10

How many anterior spinal arteries are there and what is perfuse

Answer 10

1 anterior spinal artery
perfuses anterior 2/3 of spinal cord

Question 11

Most important of paired radicular arteries

Answer 11

artery of adamkiewcz

Question 12

What does the artery of adamkiewicz perfuse and where does it originate

Answer 12

anterior cord in thorocolumabr region

usually originates on left between T11 and T12

Question 13

watershed areas

Answer 13

regions of spinal cord that have single blood supply

particularly vulnerable to ischemia

Question 14

Which region of cord is highly dependent on artery supply and result

Answer 14

Thoracolumbar region of anterior spinal cord

interruption of radicular flow can cause ischemia/infarction

Question 15

Cross clamping avove artery of adamkiewicz can cause

Answer 15

anterior spinal syndrom

Question 16

s/sx anterior spinal syndrome

Answer 16

aka beck’s syndrome
1. flaccid paralysis of lowers
2. bowel/bladder dyfuction
3. loss temp and pain sensation

touch and proprioception is preserved!

Question 17

corticospinal tract is perfused by

Answer 17

anterior blood supply

(flaccid paralysis)

Question 18

Autonomic motor fibers are perfused by

Answer 18

anterior blood supply

(bowel/bladder)

Question 19

Spinothalmic perfushed by

Answer 19

anterior blood supply

loss of temp/pain sensation

Question 20

Dorsal column perfused by

Answer 20

posterior blood supply

touch/propreoception preserved

Question 21

Perfused by anterior blood supply (3)

and what is each responsible for?

Answer 21

1. corticospinal tract (r/t flaccid paralysis)
2. autonomic motor fibers (r/t bowel/bladder)
3. spinothalmic (r/t loss of temp/pain sensation)

Question 22

perfused by posterior blood supply

Answer 22

Dorsal column (touch/proprioception)

Question 23

Amaurosis Fugax

Answer 23

blindness in one eye

sign of impending stroke

emboli from ICA to opthalmic artery

Question 24

Best neuro monitoring

Answer 24

an awake patient

Question 25

CPP =

Answer 25

MAP - ICP (or CVP, whichever is higher)

Question 26

What increases EEG frequency

Answer 26

1. mild hypercarbia 2. early hypoxemia 3. seizure 4. ketamine 5. N2O 6. light anesthesia

Question 27

What decreases EEG frequency

Answer 27

1. very hypercarbic 2. hypoxic 3. cerebral ischemia 4. hypothermia 5. OD of anesthetic 6. opioids

Question 28

carotid stump pressure that indicates possible cerebral hypoperfucsion

Answer 28

<50 mmHg carotid stump measurement is taken distal to clamp

Question 29

Surgical stimulation of carotid endardectomy can activate

Answer 29

baroreceptor relfex

Question 30

baroreceptor relfex management

Answer 30

1. glycopyrrolate (possibly pre medicate) 2. ask surgeon to stop 3. infiltrate carotid body with local anesthetic

Question 31

Hypercarbia can create a (carotid endardectomy)

Answer 31

steal phenomenon and shunt blood away from hypoperfused cerebral tissue

Question 32

Carotid endardectomy hematoma considerations

Answer 32

can cause compromised airway may not see it at site but can cause tracheal deviation may need trach

Question 33

balloon inflation in carotid artery stenting

Answer 33

Balloon inflation-->baroreceptors-->bradycardia-->hypotension pretreat with glycopyrrolate or atropine

Question 34

most common complication of carotid artery stenting

Answer 34

thromboembolic stroke d/t debris

Question 35

TransCarotid Artery Revascularization

Answer 35

blood flow is reversed in area of blockage reducesrisk of stroke during balloon inflation

Question 36

reversal of blood flow in TCAR reduces risk of

Answer 36

stroke during balloon inflation clot gets caught in machine