Valvular heart disease and anaesthesia: quiz. Vascular heart disease is basically the presence of issues with parts of the heart which cause a problem when it comes to blood flow. It is necessary for people undergoing surgery to be sedated during the process. In this quiz, you will get to test out just how much you know about the characteristics See moreone will exhibit and knowing which ones are expected and how to take care of the patient.
Serial H&H and ABG’s
Bair Hugger for lower extremities
A-Line
Fluid Warmer
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Suprarenal
Juxtarenal
Infrarenal
Pararenal
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CAD
Diabetes
CVA
Liver dx
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During cross-clamp, vasoconstrict to keep BP slightly elevated and restrict fluids
You should have a central line, A-line, and large bore IV’s
During cross clamp you should turn off heating blankets
All the above are true
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Active Infection
AAA rupture
Severe COPD
Severe cardiac Disease
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Left A-line
Femoral Central catheter
Large bore IV’s
Serial ABG’s
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Alkalotic ABG
Sudden increase in SVR
A sudden increase in ETCO2
Need for NTG drip
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26 mg
75 mg
90 mg
38 mg
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Hypotension
Bradycardia
Hemorrhage
Allergic reaction
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ETCO2 27
ETCO2 36
ETCO2 48
Wherever the pt tolerates best
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Hypotension
Myocardial Ischemia
Hypertension
Pulmonary HTN
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Exaggerated hypotensive response to induction
Hypertension upon intubation of pt
Chronic volume depletion requiring fluid boluses during surgery
Resistance to vasoactive medications, requiring higher doses
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You should seek to reduce BP to normal range.
10%
5%
20%
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Stage 4
Stage 3
Stage 2
Stage 1
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Aortic Stenosis
Aortic Regurge
Mitral Stenosis
Mitral Regurge
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Aortic Stenosis
Aortic Regurge
Mitral Stenosis
Mitral Regurge
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Concentric Hypertrophy
Ischemic Cardiomyopathy
Eccentric Hypertrophy
Tamponade
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Hypertension
Aortic Regurge
Left Ventricular Hypertrophy
Rheumatic Fever
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Equal to or slightly below baseline
Keep HR elevated above baseline
Aim for a HR >80 bpm
Aim for HR
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These patients are more prone to a-fib
Pavulon is a good choice for facilitating intubation
Sedative drugs should be given at a reduced dose, due to increased risk for ventilator depression
Use caution with fluid therapy as these pts are more prone to fluid overload
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Ketamine is drug of choice for induction of pts with severe MS
Narcotics and propofol infusions should be avoided due to myocardial suppression
Rocuronium or Sux would be drugs of choice for intubation of MS pts
Aggressive fluid therapy is necessary due to chronic fluid depleted state and risk for hypotension
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Prominent V wave
Absent A wave
Will show decrease wedge pressure
Large A wave
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Myocardial Infarction
Rheumatic fever
Mitral Stenosis
Severe hypertensive episodes
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Ketamine may be used for induction of MR patients
Decreases in SVR should be avoided
Decreases in HR should be avoided
Reversal of NMB may be done as usual
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Absent A wave
Will show decrease wedge pressure
Prominent V wave
Large A wave
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Swan Ganz line
A-Line
Large Bore IV’s
All the above are required
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Inhalational induction with desflurane
Ketamine IV induction
Propofol IV Induction
High dose fentanyl induction
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Sudden decreases in SVR should be avoided
For reversal, Atropine is preferred over Robinul
There is an increase in myocardial O2 demand
Maintenance is preferable with N2O and high dose narcotic
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Aortic Stenosis
Mitral Regurge
Aortic Regurge
Mitral Stenosis
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1
2
3
4
5
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Hypotension to prevent blood loss within the surgical field
Hypertension and tachycardia to maintain CPP
High-normal BP range to maintain CPP
No blood pressure concerns
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Atropine
Infiltration with local anesthestic
Release of traction by surgeon
All the above are acceptable interventions
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Less post-op complications
Continuous neurological assessment
Less incidence of transient ischemia
Less hemodynamic fluctuations
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On the right side because in case occlusion to left occurs
In femoral site due to risk of occluding the innominate
On the left side because you want to know how well the operative side is perfusing
Either side is acceptable
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Hemorrhage
HTN due to denervation of carotid baroreceptors
Injury to RLN
Injury to the optic nerve due to hypoperfusion
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Vasodilators
Increase minute ventilation
Calcium Chloride
Sodium Bicarb
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Decrease in preload
Increase in contractility
Increase in afterload
Mitral regurgitation
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Mannitol
Lasix
Fenoldopam
Hydration
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Median sternotomy and CPB
Median sternontomy with deep hypothermic circulatory arrest
Cross clamping with thoractomy using OLV
Cross clamping using retroperitoneal approach
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Median sternotomy and CPB
Median sternontomy with deep hypothermic circulatory arrest
Cross clamping with thoractomy using OLV
Cross clamping using retroperitoneal approach
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Median sternotomy and CPB
Median sternontomy with deep hypothermic circulatory arrest
Cross clamping with thoractomy using OLV
Cross clamping using retroperitoneal approach
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Administer a diuretic
Administer a positive inotropic agent
Administer a positive inotropic agent in combination with vasodilator
Administer a negative chronotropic agent
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Atrial flutter
Atrial tachycardia
Atrial fibrillation
Paroxysmal atrial tachycardia
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Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
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Mitral stenosis
Aortic stenosis
Mitral prolapse
Aortic regurgitation
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Vasodilation
Bronchodilation
Vasoconstriction
Myocardial stimulation
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Mitral stenosis
Aortic stenosis
Aortic regurgitation
Coronary artery disease
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Increased SVR
Increased MAP
Increased CO
Decreased EF%
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