Exam 4 Flashcards
(54 cards)
T/F: Perioperative β- blockade started within 1 day or less before noncardiac surgery increases the risk of hypotension, bradycardia, stroke, and death.
TRUE
Perioperative β- blockade started within 1 day or less before noncardiac surgery prevents nonfatal myocardial infarctions (MIs) BUT ALSO increases the risk of hypotension, bradycardia, stroke, and death.
β-blockade therapy should be instituted _______ days before surgery and titrated to a target
heart rate between __ and ___ beats per minute (bpm)
7-10 days
50-60 bpm
List some cardioprotective effects of statins:
- reduce vascular inflammation
- decrease the incidence of thrombogenesis
- enhance nitric oxide bioavailability
- stabilize atherosclerotic plaques
- lower lipid concentrations
a statin should be instituted __ days prior to the surgical procedure and continued
throughout the postoperative period
30
List Some Risk Factors Related to the Development of Atherosclerotic Lesions (13):
- Advanced age
- Smoking
- Hypertension
- Diabetes mellitus/insulin resistance
- Obesity
- Family history/genetic predisposition
- Physical inactivity
- Male gender
- Hyper or Hypohomocysteinemia
- Elevated C-reactive protein
- Elevated lipoprotein
- Hypertriglyceridemia
- Hyperlipidemia
Conditions and Traits Associated With Development of Abdominal Aortic Aneurysm (10)
- Smoking
- Older age
- Gender (more common in males than in females)
Family history - Coronary artery disease
- High cholesterol
- Chronic obstructive pulmonary disease
- Height (per 7-cm interval)
- Hypertension
- Peripheral vascular occlusive disease
- Whites
Which risk factor is the most highly correlated with AAA?
Smoking is the risk factor that is most highly correlated with
AAA.
Surgical intervention is recommended for
AAAs ___ cm or greater in diameter
5.5 (5)
T/F: An aneurysm has the potential to rupture regardless of its size.
TRUE, an aneurysm has the potential to rupture regardless of its size.
As the diameter of the aneurysm increases in size, however, the risk of rupture increases.
T/F: Prophylactic coronary revascularization reduces the incidence of perioperative cardiac events.
False
Prophylactic coronary revascularization does NOT reduce the incidence of perioperative cardiac events.
What is the primary method of intraoperative cardiac assessment in patients
undergoing surgery on the heart and the aorta?
TEE
what is a good analgesic option for patients with severely decreased ejection fraction?
Dexmedetomidine
functions to inhibit the sympathetic nervous system by decreasing central catecholamine release, does not inhibit respiration, and provides postoperative analgesia
what considerations should be taken with inhalation anesthetics for patients with CAD?
all inhalation anesthetics may depress the myocardium and cause hemodynamic instability. therefore high concentrations of inhalation agents should not be used in patients with a moderate to severe decreased ejection fraction
benefits of epidural anesthesia (8)
(1) decreased preload and afterload,
(2) preserved myocardial oxygenation,
(3) reduced stress response,
(4) excellent muscle relaxation,
(5) decreased incidence of postoperative thromboembolism, (
6) increased graft flow to the lower extremities, (
7) decreased pulmonary complications, and
(8) improved
postoperative analgesia
potential disadvantages of epidural anesthesia
possibility of an epidural hematoma (increases with anticoagulation) and severe hypotension during blood loss or unclamping
T/F: General anesthesia with TEA does not increase the risk of mortality, MI, or
neurologic complications compared to GA alone
TRUE
The use of a combined general anesthesia and epidural anesthesia provides the benefits of epidural anesthesia with the ability to provide amnesia and controlled ventilation.
Urinary output parameter for vascualr surgery
urine output of at least 1 mL/kg/hr.
Cardiovascular function must be closely monitored in the ICU for at least ___ hours after surgery
24
most common symptoms of a ruptured AAA
severe abdominal discomfort or pain
altered LOC caused by hypotension
pulsatile abdominal mass
other: syncope, groin/flank pain, hematuria, groin hernia
A patient with known AAA and cardiac disease is hypotensive in Preop. what should be done?
immediately transfer to OR for surgical exploration
Actions to protect kidneys with clamping of the aorta
minimize nephrotoxic medications such as NSAIDs (i.e. Toradol) and aminoglycoside antibiotics (i.e. gentamycin)
highest risk of kidney failure with which type of AAA
suprarenal clamp-time longer than 30 minutes
most significant in decreasing spinal ischemia?
short cross-clamp time
T/F: bair hugger is an appropriate method of maintaining normothermia during vascular surgery
FALSE
Bair huggers are contraindicated during vascular surgery clamping
