Term
| During anastamosis to the coronary artery do you want the BP up or down? |
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Definition
| Up (I'm assuming) and you do this by increasing IV fluids and possibly infusing a low-dose vasopressor. |
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Term
| During proximal vessel anastamosis (during off-pump cardiac procedure) do you want BP up or down? |
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Definition
| Down to 90-100 mmHg systolic (IV nitro is commonly used) |
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Term
| What device is used during off-pump cardiac procedures that allows for good hemodynamic stability (they used to have to use a lot of beta-blockers to reduce heart rate induced by cardiac compression)? |
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Definition
| Epicardial stabilization devices (Octopus). |
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Term
| T or F: Half to 1/4 doses of anticoagulant is used for off-pump cardiac procedures. |
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Definition
| False, 1/2 to full doses of anticoagulant are used and the CPB machine is primed and ready to use. |
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Term
| Why might you use a volatile as opposed to a high narcotic technique for off-pump procedures? |
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Definition
| volatiles have been shown to be cardioprotectant. Additionally, a goal of off-pump procedures is earlier extubation and recovery. |
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Term
| Can you do 3-vessel procedures, redos, and pts. with poor LV function off-pump these days? |
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Definition
| Yup...they're gettin sicker. |
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Term
| What's the major concern(s) with off-pump procedures? |
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Definition
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Term
| Why might we have a problem detecting ischemic changes with standard ECG and TEE during off-pump procedures? |
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Definition
ECG: the retractor produces low amplitude ECG with axis deviation. ST segment changes, therefore, can be obscure or misleading.
TEE: heart may have a lap pad behind it or lifted slightly out of the chest. This elevation may also lead to falsely elevated CVPs.
So, "DIRECT OBSERVATION OF THE HEART AND SURGEON COMMUNICATION IS CRITICAL TO AVOID THE HEMODYNAMIC SWINGS AND SUBSEQUENT ISCHEMIA." |
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Term
| The coronary artery is occluded to isolate the anastamosis site-->this yields ischemia. What kinds of bad things are likely to happen with a RCA occlusion? |
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Definition
- Bradycardia
- Atrial arrhythmias
- Heart blocks--->put on pacer pads before the procedure
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Term
| Critical left-sided coronary artery lesions may cause what types of symptoms? What might you need to treat these problems? |
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Definition
- malignant ventricular arrythmias
- hemodynamic collapse
you might need inotropes, vasoconstrictors, and volume. An IABP may be placed or they may revert to CPB. |
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Term
| At what volatile "dose" do you lose the cardioprotectant effect? |
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Definition
| 2 x MAC (Highly doubt you're ever gonna use this on a patient with a shitty heart though) |
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Term
| Anticoagulant therapy with off pump procedures is highly variable (maybe full anticoagulation, maybe half-dose anticoag..maybe reverse with protamine, maybe not). Post-op pain control can be variant/multimodal as well. List some ways you might treat post op pain. |
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Definition
- narcs
- NSAIDS (if kidneys ok...doubt the surgeon's gonna think this is a good idea though!)
- epidurals
- skin infiltration
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Term
| A majority of centers still use bypass. Why might this be so if doing things off-pump typically results in shorter hospital stays? |
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Definition
- CABG on pump is less bloody
- long term graft patency and anastamosis integrity may be improved.
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Term
| I'm thinking of two types of cases that typically use deep hypothermic arrest; what are they? |
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Definition
- giant cerebral aneurysms
- ascending aortic aneurysms
Deep hypothermic arrest provides motionless, cannula-free, bloodless surgical fields! Used for the big/nasty cases! |
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