Term
| When is the fetal heart developed? |
|
Definition
| Between the 6th & 8th week |
|
|
Term
| How is the fetus affected if heart development is altered? |
|
Definition
| They are protected since their lungs are not the source of gas exchange. |
|
|
Term
| How does the fetus receive O2 and nutrients? |
|
Definition
| From the umbilical vein which derives from the placenta. |
|
|
Term
| What is the first major organ of the fetus perfused? |
|
Definition
|
|
Term
| Describe fetal blood flow. |
|
Definition
-Half of the blood bypasses the liver via Ductus Venosus which connects the IVC to SVC.
-IVC (oxygenated blood) is mixed with SVC deoxygenated blood)
-From Vena cava to Right Atrium
-From Right Atrium through foramen ovale to L Atrium
-From L Atrium to L Ventricle and Aorta
-2/3 of blood from Aorta to coronaries and carotids
-1/3 of blood from Aorta into descending aorta
-Blood from the pulmonary artery joins the descending aortic blood via the Ductus Arteriosus
-From descending aorta to umbilical artery |
|
|
Term
| What keeps the Ductus Arteriosus patent? |
|
Definition
-High Pulmonary Vascular Resistance.
-Because the fetal lungs are collapsed, PVR is high which causes blood from the pulm artery to bypass the lungs and push through the PDA into the aorta. |
|
|
Term
|
Definition
-Connects IVC to SVC
-Functional @ birth
-Anatomical Closure @ 5-7days |
|
|
Term
|
Definition
-Connects RA to LA
-Functional @ birth
-Anatomical Closure @ 3 mos - 1 year |
|
|
Term
|
Definition
-Connects PA to Descending Aorta
-Functional @ 10-15 hours post birth
-Anatomical Closure @ 4-6 weeks |
|
|
Term
| Circulatory Changes from fetus to newborn |
|
Definition
After birth:
-Dramatic fall in PVR
-Increase in pulmonary BF with inflation & oxygenation of lungs )occurs @ first breath)
These changes lead to:
-Closure of Ductus Venosus
-Constriction of PDA
-Reversal of pressure gradients in RA & LA = closure of FO |
|
|
Term
| What is transitional circulation? |
|
Definition
A temporary state after birth when PVR drops but high PAP and resistance (less than utero) exist.
A PDA allows for L -> R shunting and patient survival.
A labile state where failure to maintain low PVR can lead to R-> L shunting and a reversion back to fetal circulation |
|
|
Term
| How is transitional circulation maintained? |
|
Definition
By trying to maintain some fetal circulatory pathways by:
-Maintaining a PDA w/ PGE1
-Allow normal heart circulation to occur slowly over a few weeks.
-Keep PVR low? |
|
|
Term
| What factors aid transition from fetal to mature circulation? |
|
Definition
-Normal O2 tension
-Physical expansion of the lungs
-Normal pH
-Nitric Oxide
-Prostacycline (PGI2) - a lipid molecule known as eicosanoils: inhibits platelet activation and is a pulm vasodilator |
|
|
Term
| What factor favor reversing back to fetal circulation? |
|
Definition
-Low O2 tension
-Acidotic pH
-Lung Collapse
-Inflammatory mediators: leukotrienes, thromboxane A2, platelet activating factor)
-Sepsis |
|
|
Term
|
Definition
| The force that distends the ventricular muscle to its preconstriction length |
|
|
Term
|
Definition
| The impedance that is faced by contracting heart. |
|
|
Term
|
Definition
| Cross-bridge formation within the myocyte |
|
|
Term
| Differences between myocardial function in infants vs adults |
|
Definition
THE NEONATE:
-Is less compliant to volume shifts
-Less tolerant to increased afterload
-Less responsive to increased preload
-CO is greatly affected by HR
-Resting tension is greater
-Operates at the top of the Frank-Starling curve |
|
|
Term
| How is cardiac output maintained in a newborn? |
|
Definition
| They have a fixed stroke volume, so it is maintained with a faster HR |
|
|
Term
| Is a newborn's lung compliance lower or higher than an adults? |
|
Definition
They have lower lung compliance.
This leads to higher RR and lower BP |
|
|
Term
| Is a newborn's chest compliance lower or higher than an adults? |
|
Definition
| They have a higher chest wall compliance leading to a lower FRC |
|
|
Term
| How does an infants body surface area compare to their weight? |
|
Definition
| They have a higher ratio of body surface area to body weight. |
|
|
Term
| What is different about an infants total body water content? |
|
Definition
|
|
Term
| Infant heart pressure (in mmHg) |
|
Definition
RA 5
LA 10
RV 25
LV 100
PA 25/10
Ao 100/50 |
|
|
Term
| What factors increase Pulmonary Vascular Resistance (PVR)? |
|
Definition
-Hypoxia
-Hypercarbia
-Acidosis
-Hyperinflation (high PEEP or PIP)
-Sympathetic stimulation
-High Hct
-Atelectasis (low FRC)
-Surgical Retraction
-Anesthetics (+/- Ketamine, N20) |
|
|
Term
| What Factors decrease Pulmonary Vascular Resistance (PVR)? |
|
Definition
-Oxygen (potent pulm vasodilator)
-Hypocarbia
-Normal FRC
-Low Hct
-Nitric Oxide
-Blocking sympathetic response (ie narcotics)
-Viagra (caution, may cause a 6 hour long....) |
|
|
Term
| How does CHF differ in adults and children? |
|
Definition
Adults:
-Heart ischemia leads to LV dysfunction
-LV dysfunction leads to low EF
-Low EF leads to increased LAP
Child:
-Large ventricular septal defect
-Increased blood flow to the lungs and R heart
-Increased pressure on R&L side = LV failure |
|
|
Term
| What are the S/S of CHF in newborns? |
|
Definition
-Low CO
-Increased respiratory work
-Increased metabolic work |
|
|
Term
| How does low CO present in the CHF newborn? |
|
Definition
-Tachycardia
-Poor extremity perfusion
-Gallop rhythm
-Cardiomegaly
-Hepatomegaly |
|
|
Term
| How does increased respiratory work present in the CHF newborn? |
|
Definition
-Tachypnea
-Grunting
-Nasal Flaring
-Chest wall retraction |
|
|
Term
| How does increased metabolic work present in the CHF newborn? |
|
Definition
-Failure to thrive
-Poor weight gain
(all their energy is spent on breathing instead of growing) |
|
|
Term
| How is CHF treated in newborns? |
|
Definition
-Low dose inotropes (milrinone)
-Avoid tachycardia to optimize filling time
-Vasodilators to increase flow
-Diuretics |
|
|
Term
| What are the categories of CHF in newborns? |
|
Definition
-Obstructive lesions
-Regurgitant lesions
-Shunt Lesions |
|
|
Term
|
Definition
Aortic Stenosis
Mitral Stenosis
-similar to adults |
|
|
Term
|
Definition
Mitral Regurg
Aortic Regurg
-Similar to adults
-Blood volume overload leads to ventricular dilation and failure |
|
|
Term
|
Definition
Atrial Septal Defect
Ventricular Septal Defect
Patent Ductus Arteriosus
-Direct communication and mixing of systemic and pulm blood |
|
|
Term
| List the Acyanotic Heart Lesions |
|
Definition
Atrial Septal Defect
Ventricular Septal Defect
Patent Ductus Arteriosus
Dont need to know:
AV septal defect
Pulm valve stenosis
Aortic valve stenosis
Coartation of aorta |
|
|
Term
| List the Cyanotic Heart Lesions |
|
Definition
Tetralogy of Fallot (TOF)
Tranposition of great vessels (TGA)
Hypoplastic Left Heart Syndrome (HLHS)
Dont need to know:
Pulm atresia
Total anomalous pulm venous return
Truncus arteriosus
Tricuspid vavle abnormalities |
|
|
Term
| Describe Acyanotic Shunt Lesions |
|
Definition
-When fetal openings stay open past fetal stage
-PDA, ASD, VSD are the most common
-Blood shunts from L -> R
-Decreased PBF
Amount of shunting depends on:
1. Size of the lesion
2. Relative resistances of the systemic and pulm circulations
3. The ability to manipulate PVR to control amount and direction of shunt |
|
|
Term
| Patent Ductus Arteriosus (PDA) definition |
|
Definition
| A connection between the main PA and Aorta |
|
|
Term
|
Definition
-Continuous murmur
-Widened pulse pressure
-Increased pulm blood flow
(Diastole will increase once PDA is fixed from aortic runoff)
-Resp failure
-Cong heart failure |
|
|
Term
| Why do does the PDA stay open? |
|
Definition
-Premies are unable to metabolize PGE1 (immature livers)
-Premies have decreased arterial O2 tension
(PDA closes when exposed to increased O2 tension)
-Shunts as much as 80% of CO to lungs
(can lead to Necrotizing EnteroColitis (NEC) & Resp failure) |
|
|
Term
| Medical Management of PDA* |
|
Definition
-Indomethacin: an NSAID that inhibits COX to reduce prostaglandin sythesis
(Contraindicated for IVH & Renal failure)
-Fluid restriction
-Diuretics |
|
|
Term
| Surgical Management of PDA* |
|
Definition
(If Indomethacin contraindicated)
-Left thoracotomy
-Device closure in older children and adults |
|
|
Term
| How/Why would you maintain an open PDA?* |
|
Definition
Why
-Sometimes a PDA is needed to sustain life
(HLHS, PA, TGA)
-The PDA mixes blood
How
-Prostaglandin infusion @ 0.05mCg/kg/min |
|
|
Term
| Atrial Septal Defect (ASD) |
|
Definition
-A communication between the L & R atria
-Account for 12% of CHD in peds
-Closed via median sternotomy on bypass or in cath lab if hole is small enough
Three Types (said we didn't need to know):
-Secundum
-Venosus
-Primum |
|
|
Term
| Ventricular Septal Defect |
|
Definition
-An abnormal communication between the L & R ventricle
-Most common CHD (20% of all CHDs)
-Closed w/ Sternotomy on bypass
Four types (said we don't need to know):
-Supracristal
-Infracristal
-Canal Type
-Muscular |
|
|
Term
| Recap of L -> R (Acyanotic) shunts |
|
Definition
-Develop a hyperdynamic left ventricle w/o benefit of increased systmic circulation
-Develop increased lung water which leads to L&R heart failure, Meisenger syndrome
-Increased LAP from LV continuously recirculated to the lungs
-Dyspnea and pulm edema (inc. RR & HR)
-Wheezing, diaphoresis, cardiomegaly, failure to thrive
Treatment:
1. Low dose inotropes (milrinone)
2. Avoid tachycardia
3. Vasodilators to inc. flow
4. Diuretics |
|
|
Term
| Anesthetic Management of L -> R (Acyanotic) shunts |
|
Definition
-Avoid myocardial depressants (ie Propofol)
-High narcs preferred
-Avoid all air bubbles (Bi-directional shunting can occur)
-Maintain PVR to avoid inc. L -> R shunting
-Avoid hyperventilatio (slow and easy, keep CO2 normal to high)
-Avoid 100% O2 (Induce w/ room air)
-Isoflurane is VA of choice |
|
|
Term
| What is faster for patients with L -> R (Acyanotic) shunts, inhalation induction of IV induction?* |
|
Definition
| In theory, inhalation should be faster because of incr. blood flow to the lungs. |
|
|
Term
| Describe Cyanotic Lesions |
|
Definition
-Typically R -> L shunting
-Decreased PBF (thus, cyanosis)
-Increased systemic blood flow |
|
|
Term
| Anesthetic Management of Cyanotic Lesions |
|
Definition
-Manipulate systemic perfusion: pulm perfusion by keeping FiO2 low
-Maintain CO and myocardial function
-Avoid myocardial depressants
-Maintain PGE1 until repair
-IV induction is faster |
|
|
Term
|
Definition
-R -> L shunt lesion
-Most common cyanotic heart disease
4 Anatomical Abnormalities*:
1. Large unrestricted VSD (flow goes back & forth)
2. Right Ventricular Outflow Tract (RVOT) obstruction
3. Overriding of Aorta above RVOT (aorta is open to both ventricles)
4. RV hypertrophy |
|
|
Term
|
Definition
-TOF w/ pulm atresia and VSD (total RVOT obstruction)
-TOF w/ pulm stenosis (classic)
-TOF w/ absent pulm valve syndrome (most severe) |
|
|
Term
| What are some common coexisting cardiac diseases in patients w/ TOF? |
|
Definition
-Left SVC
-AV Septal defect
-PDA
-ASD
-Interrupted IVC |
|
|
Term
| What are some associated Extracardiac Malformations in patients with TOF? |
|
Definition
-VACTERL
-Di George Syndrome
-Charge Syndrome
-Chromosome 22q 11 deletion |
|
|
Term
|
Definition
Abnormalities of:
-vertebral
-vascular
-cardiac
-tracheoesophageal
-renal
-limb abnormalities |
|
|
Term
|
Definition
-Coloboma (a hole in one of the structures of the eye)
-Heart anomaly
-choanal Atresia
-Retardation
-Genital anomalies
-Ear anomalies |
|
|
Term
|
Definition
-Extreme cyanosis
-Right ventricular outflow tract obstruction (RVOTO)
-Profound R->L shunting through VSD
-Pulm stenosis
-Infundibular or Suprafundibular stenosis |
|
|
Term
|
Definition
-No cyanosis
-Minimal RVOTO
-Net L->R shunt |
|
|
Term
| Describe the pathology of TOF? |
|
Definition
-The severity of the symptoms are determined by the severity of the RVOTO
-Non-restrictive VSD effectively equalizes pressure in both ventricles
-A restrictive VSD may cause suprasystemic RV pressures
-RV hypertrophy D/T high after load and diastolic dysfunction |
|
|
Term
|
Definition
-Infundibular spasm
-Acute drop in PBF
-Shunting of desaturated blood into systemic circ |
|
|
Term
|
Definition
Spontaneously from:
-crying
-defecation
-agitation
-injury
-fright
Precipitated by:
-Acute fall in SVR (maybe from anesthesia?) |
|
|
Term
| What can worsen the cyanosis during a TET spell? |
|
Definition
-Anemia
-Acidosis
-Infection
-Stress
-Posture |
|
|
Term
| What is the treatment for a TET spell? |
|
Definition
-100% O2
-B blockers (reduce infundibular spasms)
-Sedation/deepening anesthesia
-Morphine (to dilate PA)
-Fluids (to increase preload)
-Phenylephrine 0.1mCg/kg (to increase SVR:PVR ratio)
-Abdominal compression (to increase SVR)
-Squatting legs
-Correct acidosis
-Surgical repair |
|
|
Term
| What do we want to avoid during anesthesia of TOF patients? |
|
Definition
-Tachycardia
-Increased contractility
-Dehydration
(These 3 increase RVOTO and decrease filling time)
-Hypovolemia
-Hypotension
(These 2 decrease preload and SVR) |
|
|
Term
| What is Transposition of the Great Arteries (TGA)? |
|
Definition
-Failure of the great arteries to rotate
-Aorta and coronies arise from RV
-PA arises from LV
-Pulm and Sys circ are separate and parallel
-Venous blood is re-circulated to the RV
-Aorta is not oxygenated
Survival: from mixing of blood via VSD, ASD, or PDA |
|
|
Term
| What are some treatments for Transposition of the Great Arteries (TGA)? |
|
Definition
Balloon Atrial Septostomy:
-Creates a larger communication between atria
-Increases saturations to 80-90%
Arterial switch:
-Reimplantation of coronary arteries
-Return to normal physiology
-Residual effects of: coronary artery ischemia, aortic stenosis, or aortic regurg
Mustard Procedure:
-Make a more patent ventricular shunt
-Makes the RV systemic
-RV eventually wears out |
|
|
Term
| What is Eisenmenger's Syndrome? |
|
Definition
-Irreversible pulm vasc disease from an unrepaired cardiac shunt (often VSD)
-PVR is higher than SVR because of pulm vascular obstruction.
-The shunt changes direction from L->R to R->L
-Leads to pulm HTN and Pulm Obstructive Disease
-A fixed PVR is unresponsive to pharm manipulation
Survival: 80% 10 years after diagnosis
:42% 15 years
:30% of all pregnancies end in maternal death |
|
|
Term
| What are some S/S of Eisenmenger? |
|
Definition
-Clubbing
-Cyanosis
-Fixed pulm HTN
-R->L shunt
-Systemic HoTN (give vasopressin)
-Infective Endocarditis (need ABX) |
|
|
Term
| How do you treat a patient w/ Eisenmenger? |
|
Definition
-21-30% FiO2
-GA to control ventilation and oxygenation
-Heparin (to prevent emboli)
-De-Air lines (can lead to paradoxical air emboli)
-Minimize cardiac & vascular depression |
|
|
Term
| What is Hypoplastic Left Heart Syndrome (HLHS)? |
|
Definition
-AKA single ventricle syndrome
-Underdevelopment or absence of the LV & Asc. Aorta
-Stenosis or absence (atresia) of the aortic valve and mitral valve with little or no flow via AV
-Bloodflow is dependent on a PDA (maintained by PGE1) which provides blood to lower body, brain, coronaries in a retrograde manner
-Asc aorta is hypoplastic, atretic, or coarcted.
-Usually an ASD I present |
|
|
Term
| What happens to the chambers and valves during HLHS? |
|
Definition
-Dilated Right Atrium
-Dilated RV
-Dilated main PA
-Dilated Tricuspid orifice (entire CO passes through here)
-PFO (allows pulm venous return) |
|
|
Term
| What happens to the lungs in HLHS? |
|
Definition
Lungs are normal
Hypoxemia depends upon balance of SVR:PVR |
|
|
Term
| Describe systemic venous flow in a patient with HLHS. |
|
Definition
SVC & IVC -> RA -> RV-> PA-> PDA->AO ->Body ->SVC&IVC
(LV is bypassed) |
|
|
Term
| Describe pulmonary venous flow in a patient with HLHS. |
|
Definition
| Pulm blood -> LA -> PFO -> RA -> RV -> PA -> Lungs -> pulm blood |
|
|
Term
| What are the options for a patient with HLHS? |
|
Definition
-Cardiac transplant
-Three stage Norwood procedure
-Death (not the preferred option) |
|
|
Term
| Describe stage 1 of the Norwood procedure. |
|
Definition
-The main PA and small AO are reconstructed to make a new larger AO
-This new AO arises from the RV to provide systemic blood flow
-Atrial septectomy (hole in the atrial septum) is made to allow BF from LA to RA to bypass the hypoplastic left heart
-The pulm valve is used to construct the new aorta
-New source of PBF is provided by creating a systemic PA shunt called a BT Shunt (Blalock Taussig) |
|
|
Term
| What is the goal of stage 1 Norwood? |
|
Definition
-Create PBF w/ BT shunt
Achieved through:
-New aorta
-BT shunt
-Good common atrium |
|
|
Term
| What is the anesthetic plan for a stage 1 Norwood procedure? |
|
Definition
-Keep pulm:systemic flow @ 1:1 ratio
-Maintain SPO2 70-80s
-Avoid pulm vasodilation (high PO2 or low PCO2) |
|
|
Term
|
Definition
| -Connects the aorta to the Right PA |
|
|
Term
| Describe Norwood stage 2. |
|
Definition
-Done at 2-6mos age
-Creation of a Bi-directional cavo-pulmonary connection (AKA Glenn)
-BT shunt is taken down
-SVC is connected directly to the right PA
Stabilizes circulation by:
-Decreases load on RV
-Diverts SVC directly to lungs |
|
|
Term
| What is the goal of Norwood stage 2? |
|
Definition
| To partially separate Red & Blue blood |
|
|
Term
| Describe Norwood stage 3. |
|
Definition
-Blood from the IVC is redirected to the PA via a tube made of gortex
-Blood enters the lungs without being pumped
-Results in a RV that is exclusively for systemic circulation
-BF to the lungs depends on the transpulmonary pressure from VC into PA
-The flow is augmented by normal breathing and negative thoracic pressure |
|
|
Term
| What is the goal of a stage 3 Norwood? |
|
Definition
| Completely separate Red & Blue blood |
|
|
Term
| What are some possible SEs of a norwood and how are they treated? |
|
Definition
High R sided pressures
-Fenestration are placed in the gortex tube to allow the heart to gradually adjust to the new BF
-S/S: pleural effusions, ascites, LE edema
Low CO
-Augmented by small R -> L shunt
-Patients can desat to 85-90% |
|
|
Term
| What is the anesthetic management plan for a patient who has had a Norwood procedure? |
|
Definition
-Avoid excessive PPV (reduces the transpulmonary pressure gradient resulting in lower CO)
-Low PEEP to promote venous return
-Avoid hypovolemia
-Might need ICU postop |
|
|
Term
| What are some reports you might want when doing a surgery on a patient with a repaired CHD? |
|
Definition
-Recent physical
-Current S&S
-Previous surgical record
-Cath procedures and reports
-Recent ECHO
-EKG |
|
|
Term
| Why are TOF and single ventricle patients prone to arrhythmias? |
|
Definition
| Because their repairs involved manipulation along the conduction pathway. |
|
|
Term
| What are common medications a patient with a repaired CHD might be on? |
|
Definition
-ACE
-BB (especially TOF)
-Amiodarone (watch for arrhythmias)
-Diuretics (CHF patients)
-ASA
-Anti-platelet regimes |
|
|
Term
| Why might a patient with a repaired CHD be on Coumadin? |
|
Definition
-Might have a mechanical valve
-Avoid thrombus is created shunts |
|
|
Term
| If a patient with a repaired CHD has a PM or AICD, what do you want to know? |
|
Definition
-Underlying rhthym
-Device settings |
|
|
Term
| What is the mainstay of diagnostic testing for a patient with a repaired CHD? |
|
Definition
|
|
Term
| Does a patient with a repaired CHD always need a cardiology consult prior to anesthesia? |
|
Definition
Not if their cardiac function is corrected and compensated and they have been consistently followed by their cardiologist.
Must have a cardiology consult & ECHO within 3-6 mos:
-Complex lesion
-Not well compensated
-Cyanotic or single ventricle patient
-If they have changes significantly since their last visit to the cardiologist |
|
|
Term
| Where should surgeries be done on a patient with a repaired CHD? |
|
Definition
-Non-cardiac procedures for well compensated patients can be done at a community hospital
-Poorly compensated or single ventricle patients should be done in a specialty center
-Complex pts should be able to be admitted if needed |
|
|
Term
| What are some common preop orders for a patient with a repaired CHD? |
|
Definition
-Continue cardiac meds
-Standard NPO
-Patients with cyanotic lesions, are shunt dependent, or have an outflow tract obstruction should not be NPO for a long time (clears up to 2 hours prior)
-ASA stopped 7-10 days prior to major surgery |
|
|
Term
| What are some considerations for a patient with a repaired CHD presenting for a dental procedure? |
|
Definition
| Need excellent dental hygiene to prevent infective endocarditis |
|
|
Term
| What are some considerations for a patient with a repaired CHD presenting for a laparoscopic procedure? |
|
Definition
Caution with high insufflation pressures
-Increases intra-abdominal pressures
-hypercarbia and decr venous return result
-Not tolerated in single ventricle or fontans pats |
|
|
Term
| What are some considerations for a patient with a repaired CHD presenting for a scoliosis procedure? |
|
Definition
-Hypovolemia and HoTN not well tolerated
-Careful blood and volume replacement (esp fontan pts)
-SC monitoring |
|
|
Term
| What are some considerations for a patient with a repaired CHD presenting for a craniofacial procedure? |
|
Definition
Cleft lip. Palate, or craniosynostosis repair:
-Prevent air embolus
-monitor and treat blood loss carefully |
|
|
Term
| What should the anesthic plan be for a patient with a repaired CHD presenting for MRI or diagnostic testing? |
|
Definition
| Sedation or GA are acceptable depending on hemodynamic and resp tolerance |
|
|
Term
| What are some considerations for a patient with a repaired CHD presenting for a elective procedure? |
|
Definition
| If they have a single ventricle, the procedure should be delayed until after the cavopulmonary connection is completed. |
|
|
Term
| What are some examples of patients that should have surgery at a Tertiary Care Children’s Hospital? |
|
Definition
-Single Ventricle
-Unrepaired cyanotic CHD
-Repaired CHD w/ poor ventricular function |
|
|
Term
| For a patient with CHD, what are the considerations of using dexmedetomidate? |
|
Definition
-Works well to smooth things out after anesthesia
-Can cause bradycardia and HoTN |
|
|
Term
| For a patient with CHD, what are the considerations of using opioids? |
|
Definition
-Good option
-Used in caudals and nerve blocks |
|
|
Term
| For a patient with CHD, what are the considerations of using neuraxial blocks? |
|
Definition
| Lumbar/Thoracic spinals and epidurals should be avoided. |
|
|
Term
| For a patient with CHD, what are the considerations of using propofol? |
|
Definition
| Ok to use, but avoid venous dilation. |
|
|
Term
| For a patient with CHD, what are the considerations of using ketamine? |
|
Definition
| Good choice since it preserves myocardial function. |
|
|
Term
| For a patient with CHD, what are the considerations of using etomidate? |
|
Definition
Excellent choice.
Little effect on hemodynamics. |
|
|
Term
| What are the indications for Infective Endocarditis Prophylaxis? |
|
Definition
1) Cardiac anomaly
2) Prior to certain surgical procedures |
|
|
Term
| What are the cardiac implications for prophylaxis of Endocarditis? |
|
Definition
A) prothetic valve or material
B) previous IE
C) unrepaired CHD including shunts and conduits, completely repaired CHD with prosthetic material or device first 6 mos after procedure, repaired CHD with residual defects at or near site of prosthetic patch or device
D) Cardiac transplants |
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|
Term
| What are the surgical indications for prophylaxis of Endocarditis? |
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Definition
-Dental procedures
-Respiratory tract
-Procedures on Infected skin or musculoskeletal tissue |
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Term
| What medications are given for prophylaxis of Infective Endocarditis? |
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Definition
Ampicillin (50mg/kg Im/IV x1 max 2g/dose)
Clindamycin, Cefzolin, Ceftriaxone can also be used |
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