Term
| What is the major cause of morbidity and mortality associated with vascular surgery? |
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Definition
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Term
| What is the major goal for anesthesia for vascular surgery? |
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Definition
| To preserve myocardial function. |
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Term
| Besides myocardial dysfunction, what are some other causes of vascular related morbidity? |
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Definition
- Pulmonary infections
- renal insufficiency/failure
- hepatic failure
- CVA
- Spinal cord ischemia
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Term
| What is the most common cuase of occlusive disease in the arteries of the lower extremities? |
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Definition
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Term
| What are the 8 predisposing factors for atherosclerosis? Which 2 did Gayle highlight? |
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Definition
- Age
- lipid levels and lipoprotein profiles
- HTN
- obesity
- inactivity
- male gender
- smoking
- diabetes
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Term
| It's safe to assume that if your patient has carotid artery disease that they have what other two conditions? |
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Definition
| Peripheral vascular disease (PVD) and coronary artery disease (CAD) |
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Term
| Intimal vascular plaques consist of oxidized lipid accumulations, inflammatory cells, smooth muscle cells, connective tissue, and calcium deposits. Morbidity associated with plaque enlargement and luminal obstruction is highest in what 5 areas? |
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Definition
- coronary
- carotid bifurcation
- infrarenal
- abdominal aorta
- iliofemoral vessels
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Term
| Give me a summative list of the approaches to treating atherosclerosis. |
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Definition
- STOP SMOKING SHITHEAD! (The most effective therapy)
- Antiplatelet therapy
- anticoagulation (if acute ischemia is present)
- Antilipid therapy (statins)
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Term
| The most common cause of carotid disease is atherosclerosis and it most commonly occurs at the carotid bifurcation because wall stress is greatest here. Bilateral carotid disease occurs in what percentage of cases? |
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Definition
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Term
| Most cerebrovascular accidents (CVA) are preceeded by what? |
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Definition
| TIA (transient ischemic attack) |
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Term
| Will you always hear a bruit in patients with critical atherosclerotic lesions of the carotid artery? |
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Definition
| No, not necessarily. Even if they do have bruit, this does not indicate a critical lesion...a bruit just means that additional testing (duplex scan which measures velocity) is necessary. |
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Term
| Amaurosis fugax can occur with embolization of what two vessels? |
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Definition
Ophthalmic a.
Retinal a. (which is a branch of the ophthalmic a.) |
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Term
| What test measures the size and morphology of a carotid artery plaque and also documents coextisting aortic and cerebral artery involvement? |
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Definition
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Term
| What % of strokes are fatal? |
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Definition
1/3 fatal
1/3 result in significant residual defects |
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Term
| In patients with severe CAD and carotid artery disease it can be difficult to decide whether to perform a CABG 1st or a CEA 1st. How do people decide? |
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Definition
| They risk stratify. For example, a patient with 3 vessel disease and who demonstrates myocardial ischemia may have a CABG 1st. The surgeon's comfort level is another factor. |
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Term
| What's the drawback to doing a CABG before a CEA in a patient who needs both procedures? |
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Definition
| You risk brain hypoperfusion when you go on pump due to the nonpulsatile flow. |
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Term
| Protecting/not stressing the heart can be difficult during a CEA can be difficult. Preserving brain function/perfusion is at odds with preserving heart function. List some basic principles that should be remembered for for carotid surgery. |
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Definition
- Maintain BP within normal range.
- Utilize mild hyocapnia to avoid steal phenomenon associated with hypercapnea
- Use normal saline (avoids increasing the penumbra due to LR conversion to glucose via the cori cycle).
- Usually use iso b/c of neuroprotective value (CBF the least-->reduces cerebral steal (?) and reduces also reduces CSF production)
- Avoid nitrous (pneumocephalus) or turn it off before cross-clamping.
- Use passive hypothermia for cerebral protection. Don't let them wake up shivering though!
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Term
| Articulate the advantages of using GA for CEA. |
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Definition
- Pt. cooperation not an issue
- can manipulate cerebral blood flow with ventilation if needed
- secured airway
GA is how most CEAs are done |
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Term
| What are the disadvantages of using GA for CEA? |
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Definition
- pt. can't provide immediate feedback
- intubation carries risk
- cost
- cardiac depressant exposure.
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Term
| What dermatomes must be blocked for regional for CEA? |
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Definition
| superficial and deep C-2 to C-4 block |
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Term
| What are the advantages of regional for CEA? |
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Definition
- Better BP control
- easy cerebral monitoring
- no intubation
- no cardiac depression
- cost effective
Disadvantages:
no cerebral protection
bad location if intubation required
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Term
| Is there a difference in neurological outcomes between regional and GA for CEA? |
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Definition
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