Term
Aside from all the things we know we need to do w/ an induction, what is important to note PRIOR to induction for hearts (think monitors..)? |
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Definition
FILLING PRESSURES & ST segment
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Term
What is your primary concern w/ induction of heart patients? |
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Definition
preventing myocardial ischemia |
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Term
What type of induction should you use and how is it done? |
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Definition
SLOW-use midazolam, LARGE doses of opioids, LOW doses of volatiles, sedative hypnotic of your choice & muscle relaxant |
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Term
Name six things your should do post induction. |
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Definition
1) Draw baseline labs
2) Get a CO
3) Deepen anesthetic (gradually)
4) drop an OGT/NGT
5) Use the TEE
6) Give an antifibrolynic (amicar 150 mg/kg) or Aprotinin |
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Term
Your patient has a CI of 1.7 l/min/m2, bp 126/82 and HR 68, should you fix them? |
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Definition
| No, when the patient has a normal BP, the delivery perfusion is adequate. Fixing it can cause more problems for you. |
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Term
When is endovein harvesting done? What does it tell you? |
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Definition
Its done before sternotomy. It lets you gauge depth of anesthesia and narcotic for the sternotomy. |
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Term
What are your two stimulating events? |
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Definition
Skin incision & sternotomy |
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Term
What's your role during sternotomy? |
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Definition
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Term
What is the most common time for recall? |
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Definition
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Term
Your doing a redo heart, and oh crap the RV or aorta was entered. List what you MUST do: |
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Definition
1) Steep trendelenburg
2) Give heparin
3) Possibly pack the head in ice
4) Pentothal 30 mg/kg |
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Term
Is there alot of stimulation during LIMA dissection? What might you expect? |
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Definition
NO-there's minimal stimulation
You might expect wide swings in HR and BP because of the sympathetic fibers on the pericardium |
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Term
What is your heparin dose? When is it given? |
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Definition
300-400 u/kg, given IVP through a central line before the aorta is cannulated |
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Term
When do you draw an ACT? What do you want it to be before CPB initiation? |
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Definition
Draw it 3-5 min after bolus
You want an ACT of 400 sec |
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Term
What is cannulated first? |
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Definition
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Term
Can can venous cannulation lead to? |
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Definition
Significant BP drops & arrhythmias |
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Term
What does right atrial cannulation drain? What may happen to your CO & BP? |
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Definition
It drains the superior and inferior vena cava, it may decrease CO and BP |
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Term
What is the target temp for pump cases? |
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Definition
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Term
What is our role prior to aortic cannulation? |
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Definition
Reduce BP to assist w/ cannulation and prevent laceration of the aorta |
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