Anesthesia for Cardiac Surgery

Cardiac Anesthesia Potpourri

100

aminocaproic acid (Amikar) & aprotinin

Antifibrinolytic agents

slide 22

200

Which anesthetic agents produce a preconditioning effect on the mycardium?

Volatile agents:  Especially Sevoflurane and Isoflurane

300

Associated with increased incidence of arterial spasm, but generally remain patent for a longer period of time

LIMA/ITA grafts

Slide 13

400

Percentage of cardiac cases that return to the OR for bleeding

4 - 5%!!

Slide 48

500

An S3 Heart sound is often a sign of.... ?

Systolic heart failure

Overly compliant ventricle= dilated LV

AKA- "ventricular gallop)

Check that History

100

Name 5 risk factors for CAD

Male, age, smoking hx, family Hx, DM, Obesity, Personality, HLD

Slide 5

200

Identify 4 determinants of myocardial oxygen supply

Coronary artery anatomy/patency, diastolic blood pressure, diastolic time (HR), Hb, Oxygen tension/saturation

Slide 4

300

EF <25%

Severe LV dysfunction

Slide 9

400

Independent risk factor for perioperative M&M

Renal disease/Chronic renal insufficiency

(Up to 40% for ARF and 60%+ if needing replacement therapy!)

Slide 8

500

LBBB on ECG

Can become 3rd degree block with PA Cath placement

Slide 10

I'm Gonna Pump You Up

100

Name 5 basic components of the CPB machine

Venous Reservoir, main pump, oxygenator, heat exchanger, arterial filter

Slide 32

200

Name the suction used to drain blood collecting in the mediastinum

The Cardiotomy suction

Slide 33

300

Describe the cardioplegia solution

Cold, hypertonic crystalloid solution that contains potassium and many other additives including lidocaine, aspartate, glutamate, dextrose, mannitol, bicarb and or adenosine

Slide 30

400

Instantaneous hemodilution and reduction of blood viscosity

Causes of initial Hypotension following initiation of CPB

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500

ALI/ARDS, AKI, SIRS, MI, TIA

Complications associated with CPB

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Procedural Awareness

100

What Blood Pressure is recorded while the patient is "on-pump"?

MAP

Slide 29

200

Wide Receiver Most Valuable Player

Off pump checks!

Warm. Rhythm. Monitors. Ventilation. Perfusion

Slide 43

300

Strictures, varices, diverticula or recent suture lines.

Contraindications to TEE

Slide 19

400

Ensure adequate muscle relaxation, hold ventilation, allow exhalation and be prepared for resuscitation

Anesthetist actions prior to sternotomy

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500

The desired outcome of cardioplegia

Hypothermic, diastolic cardiac arrest

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Manage That Case

100

Distant heart sounds

Distended jugular veins

Decreased arterial pressure

Beck's Triad - associated with cardiac tamponade

Slide 48

200

How do you calculate SVR?

SVR = [(MAP - CVP)/CO]*80

Slide 44

300

What is the reversal dose for Protamine?

1mg protamine per 100 units heparin administered

Slide 44

400

Identify and Treat:

Persistently low blood pressure (SVR) despite normal to high cardiac output

Vasoplegic syndrome!! 

Treat with norepinephrine and vasopressin

Slide 45

500

HAD2SUE

On-Pump checklist:

Heparin, ACT, Drugs/Drips, Swan, Urine, Emboli

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I'm NOT Gonna Pump You Up

100

A minimally invasive procedure for the correction of severe AS

TAVR (transaortic valve replacement) or

TAVI (transcatheter aortic valve implantation)

200

Name 2 approaches for the TAVR procedure

Retrograde :trans-femoral

Antegrade: left ventricle apex (via minithoracotomy)

300

The Octopus, Urchin and Starfish: stabilizing devices used during off-pump CABG procedures

Slide 51

400

Medications generally not needed for "Off-Pump" CABG

Heparin, antifibrinolytics and protamine

500

List hemodynamic parameters for management of Aortic or Mitral Stenosis

Preload = up

Afterload = maintain

SVR = maintain

HR = 50 - 80

Slide 52