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topic 13 Flashcards

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1
Q

hypoxia

A

inadequate oxygen to tissue

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2
Q

ischemia

A

inadequate blood to tissue

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3
Q

type 1 morbid neuroligical outcome

A

cerebral death, non fatal strokes, new tia

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4
Q

type 2 morbid neuroligical outcome

A

new intellectual deterioration, new seizures upon discharge

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5
Q

type 1 predictors

A

70 4-9%risk, aortic atherosclerosis, hisory of prior neurological events-15% carotid stenosis

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6
Q

type 2 predictors

A

Low cardiac output states  Atrial arrhythmias  Systolic Hypertension  Diabetes
 Pulmonary Disease  Excessive Alcoholism

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7
Q

neuro impairment

A

6.1%

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8
Q

post op delireum

A

10-60%

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9
Q

transient dysfunction

A

7-44%

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10
Q

permanent complications

A

1.6-23%

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11
Q

highest neurological risk during surgery

A

filling heart

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12
Q

how do perfusionist contribute to neuro injury

A 
Focal  Embolism
 Air  Plaque  Microemboli  Left ventricular thrombus  Fat  Debris
 Hypoperfusion  Inflammation
 Global  Complete
 CardiacArrest  Deep Hypothermic
Circulatory Arrest  Incomplete
 Hypotension  Inadequate CPB flow
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13
Q

inflammation

A

ischemia reperfusion injury causes activation of leukocytes

vascular integrity causes foreign surface capillary plugging and liberation of free radical

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14
Q

tailoring o2 delivery

A

MAP, CO2,CI AND pump flow, HCT, mechanical issue

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15
Q

tailoring O2 consumption

A

anesthetic agent and depth temperature

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16
Q

brain monitoring

A

neuro exam, BP monitoring, EEG, Bispectral index, transcranial doppler, intra cranial monitoring, sat. of jugular venous O, venous sat. global, regional sat. of O2

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17
Q

EEG

A

records elec. activity of brain, 10-20 eectrodes or 2-4 leads, FTPO, odd # left hemi., even right hemi

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18
Q

alpha

A

8-13 hz. amp is medium,occipital, ralaxed awake

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19
Q

beta

A

13-30 hz, amp is low, frontal, alert awake

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20
Q

theta

A

4-8 hz., amp is high, diffuse, sleeping infant or child

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21
Q

delta

Study These Flashcards
A

0-4 hz. amp is high, diffuse, coma ischemia deep sleep, deep anesthesia

22
Q

clinical use of EEG

Study These Flashcards
A

 Main Reason  Epilepsy
 BrainTumors  Stroke  Focalbraindisorders
 Secondary reason  Diagnosis of coma  Encephalopathies  Brain death
 Monitor depth of perfusion
 Indirect indicator of cerebral perfusion in carotid endarterectomy

23
Q

disadvantages in OR from EEG

Study These Flashcards
A

EG signal information is generated from low voltages 50-100 μV in the electrically hostile operating room environment
 Analysis is complex  Distracting anesthesiologist from patient care  Electrode impedances
 Equal – interference is eliminated
 Different – appear as artifact  Electrical devises in OR
 Pacemakers  ECG  Electrocautery units
 Electrical activity in skeletal and cardiac myofibrils  Patients moving  Patients shivering
 Electromechanical devises  Heart lung machine

24
Q

BIS

Study These Flashcards
A

Process EEG INFO. approved in 1996, info displayed every 10-15 sec, non invasive,graph and numerical trends, allows anesthesia ability to access eeg info during case. uses numbering system to identify depth of anesthesia

25
how does bis work
processes signals and assesses relationships among signal components and captures synchronization within signals like eeg. then converts it to a digital # for easy interpretation
26
bis index
1-100. 100 is fully awake 80 responds to loud commands or shaking, 60 general anesthesia unresponsive to verbal stimulus, 40 deep hypnotic state, 20 burst suppresion, 10 flat line eeg
27
pet scan
100% bmr bis 95, 64% 66, 54% 62, 38% 34
28
opiod anesthesia bis value
40-60
29
opioid with volatile gas
25-35
30
target to titrate
45-55
31
BIS helps us
maintain hemodynamics
32
benefits of bis
Reduction in primary anesthetic use  Decrease incidence of intraoperative awareness and recall  Reduction in emergence and recovery time  Improved patient satisfaction
33
disadvantages of bis
It is a trending device  We can’t be responsible to treat the level of sedation  Often monitor only faces anesthesia
34
transcranial cerebral oximetry
Transcranial cerebral oximetry is a non-invasive technique for monitoring changes in cerebral oxygen metabolism, which presents additive information when the conventional key variables (as peripheral oxygenation and/or systemic hemodynamics) would not be predictive.
35
tco benefits
Noninvasive, continuous, direct, real time  Site-specific (regional) measure vs systemic; often signals earlier warning of reversible ischemia  Added ability to detect and correct oxygenation issues that can lead to complications and poor outcomes  Not pulse, pressure or temperature dependent  Immediately reflects patient reactions to each stage or event during surgery and the efficacy of interventions Proven Clinical Value Clinical Benefits – continued  Simultaneous monitoring of vascular beds under different circulatory controls (cerebral and somatic/peripheral)  Identifies patient-unique rSO2 baselines for customized care  Enhances clinical assessment and decision making  Objective data vs subjective assessment
36
major organ mortality
13.4%. invos drops MOMM TO 3%
37
CVS COGNITIVE DECLINE
24-53%. `53% at discharge, 36% at 6 weeks, 24% at 6 months | and 42% at 5 years; indicating it is not transitory
38
PROLONGED VENT FROM CVS
5.96% GREATER THAN 48 HOURS
39
ADULT APPLICATION OF INVOS
Cardiac surgery  Pre-op, intra-op and post-op ICU  Traditional and robotic  Vascular surgery  Cardiac cath lab  Neurology / Neurosurgery  ER / traumatic brain injury  General surgery  Spinal injury
40
PEDIATRIC APP OF INVOS
Cardiac surgery  Pre-op, intra-op and post-op PICU  Traditional and robotic  ECMO (Extracoporeal Membrane Oxygenation)  Cardiac Cath lab (at times)  Neurology / Neurosurgery  Still being studied – must convince the caregivers that the data is useful  Sensors are improving (much work to do)
41
PLACEMENT OF INVOS SENSORS
Clean area with alcohol - let it dry • Attach sensors above the eye brows • Connect to machine •SET BASELINE Critically important to set the baseline before anesthesia induction and nasal oxygen
42
LIGHT THAT CAN PENETRATE CRANIAL TISSUE
650-1100
43
mechanical INFLOW issues to head
head Position • Heart Position • Arterial Obstruction Carotid Disease, Clamp, Hand, Sponge • Cannula Malposition
44
intervention for cerebral inflow
rule out mechanical causes like head and cannula position, increase supply by ncrease blood pressure Normalize CO2 to physiologic level Increase FiO2 Increase cardiac output (pump flow) Vasodilate cerebral blood vessels Increase hematocrit. decrease demand by increase anesthetic decrease temp.
45
cerebral rso2
detects o2 supply issues associated with o2 delivery
46
supply issues
low fio2, low hgb, low map, pump flow, spasm
47
our steps to increaes o2
increase BP, increase fio2, increase co, increase hct
48
baseline rso2 cardiac surgery patients and healthy
65 +-9, 70 +-6,
49
intervention threshold
less than 50 or 20% drop,
50
critical threshhold
less than 40 or 25% drop

Monitoring (4 decks)

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