Questions and Answers
What is the most critical period during the surgical procedure for patients with ventricular ischemia?
In which position should patients be placed for optimal exposure during a median sternotomy?
Which surgical instrument is NOT typically used in cardiac surgeries?
What type of sutures are commonly used for valve repairs or replacements?
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What must be confirmed pre-, intra-, and post-operatively regarding blood products?
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Which type of graft is most commonly used for bypassing occluded coronary arteries?
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What is essential when conducting a major count during cardiac surgeries?
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What is the purpose of cardiopulmonary bypass (CPB) during surgery?
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Which technique involves using the patient's own vein while keeping it in its natural position?
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What is a potential complication when the distal clamp is removed during aortic crossclamp application?
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Which of the following instruments is NOT typically used in vascular surgery?
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Which type of graft must be biocompatible and last a lifetime in vascular surgery?
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What is one of the requirements for vascular patches used in reconstructive surgery?
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What is the primary role of the perfusionist during cardiac surgery?
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Which component of the cardiopulmonary bypass circuit is responsible for removing carbon dioxide from the blood?
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How does cardioplegia assist during heart surgery?
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Before performing an aortocoronary bypass, which procedure is typically carried out to manage blood flow?
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What is the main advantage of using the Internal Mammary Artery (IMA) as a graft in CABG procedures?
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Which type of blood drainage is facilitated by the venous cannula during cardiac surgery?
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Which of the following statements about the saphenous vein in CABG procedures is accurate?
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What purpose does the heat exchanger serve in the cardiopulmonary bypass circuit?
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What is the function of the aortic crossclamp during heart surgery?
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Which condition is primarily treated with aortocoronary bypass grafts?
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What is the primary advantage of using the Left Internal Mammary Artery (LIMA) over a saphenous vein for coronary artery grafting?
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Which procedural consideration is not typically required in vascular surgery?
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Which mechanism primarily causes valve stenosis?
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What is a potential consequence for a patient receiving a mechanical heart valve?
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Which arteries are utilized during coronary artery bypass grafting?
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What type of valve replacement would likely require lifelong anticoagulation therapy?
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Why are arteries preferred over veins for grafting in coronary artery bypass surgery?
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In which scenario would the Right Internal Mammary Artery (RIMA) be used?
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What is the primary reason for performing coronary anastomoses?
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Which procedural consideration is crucial when selecting a conduit for grafting?
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What differentiates arteries from veins in terms of wall composition?
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Which statement regarding the functions of veins is accurate?
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What is a characteristic of papavarine in vascular surgery?
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In patients with vascular disease, which of the following symptoms can indicate peripheral ischemia?
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Which medication is specifically mentioned as used for irrigation during vascular surgery?
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What is a defining feature of chronic arterial insufficiency?
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Which of the following statements about acute venous insufficiency is correct?
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Which of these pairs correctly matches a medication with its primary use?
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What is the primary role of valves in veins?
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Which layer of blood vessels is responsible for contraction and regulating blood flow?
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Study Notes
Anaesthesia and Patient Care
- General anaesthesia with endotracheal tube (ETT) is required for ACB or valve surgeries.
- Induction is critical, necessitating close monitoring, especially in patients with ventricular ischemia.
- All surgical team members must be present during anaesthesia induction.
- Extensive tissue dissection may necessitate blood transfusions; pre-, intra-, and post-operative blood product availability must be ensured.
- RPN should be prepared with hemostatic agents like hemoclips, sutures, Gelfoam, and Surgicel for immediate surgical needs.
Patient Positioning
- Median sternotomy is performed for valve replacement/repairs or ACB.
- Patients are positioned supine to optimize surgical exposure.
- Adhere to ORNAC Standards and a positioning performance checklist for safety.
Cardiovascular Instrumentation
- Common cardiac instruments include:
- Potts scissors, Castroviejo needle holders, Ryder needle holders, Debakey or Cooley forceps, and vascular forceps.
- Sternal retractors, tubing clamps, and femoral Debakey clamps.
- Grafts for ACBs generally consist of saphenous vein or arterial conduits.
- Surgical sutures include Surgipro or Prolene (polypropylene) and Ticron (polyester).
- Minor count required during surgery: Initial Count → Closing Count → Final Count.
Cardiopulmonary Bypass (CPB)
- CPB temporarily substitutes the heart and lungs by diverting blood, managed by a perfusionist.
- Surgeons stop the heart to proceed with surgery, ensuring a motionless surgical field.
- Cannulae inserted:
- Venous cannula diverts deoxygenated blood.
- Arterial cannula returns oxygenated blood.
- Cardioplegia catheter administers cardioplegia to protect the myocardium from ischemia.
- CPB circuit components include a venous reservoir, oxygenator, heat exchanger, and centrifugal pump.
Surgical Interventions
- Aortocoronary Bypass Grafting (CABG) treats Coronary Artery Disease (CAD) and revascularizes ischemic areas using arterial and venous conduits.
- Common grafts include:
- Internal Mammary Artery (IMA) known for excellent long-term patency
- Saphenous Vein, harvested endoscopically
- Radial Artery
- Procedural stages involve median sternotomy, conduit selection, anastomoses, and closure.
Valve Repair or Replacement
- Necessary for stenosis (narrowing) or regurgitation (backflow) of valves.
- Perioperative nurse must verify valve type (mechanical or bioprosthesis) for replacement.
- Mechanical valve recipients will require long-term anticoagulation therapy.
Vascular Anatomy and Function
- Arteries: Thicker walls, more elastic fibers, capable of constricting to stop hemorrhage, carry blood away from the heart.
- Veins: Thinner walls, valves to prevent backflow, carry deoxygenated blood back to the heart.
Vascular Disease and Considerations
- Common arterial diseases: Aneurysmal disease, chronic arterial insufficiency (e.g., atherosclerosis).
- Common venous diseases: Chronic venous insufficiency.
- Vascular surgery focuses on bypass and reconstruction for these conditions.
Medication and Solutions
- Common intraprocedural medications:
- Heparinized saline, vasodilators like papaverine, and contrast dye.
- Topical agents like absorbable gelatin sponge may promote hemostasis.
- Adhere to ORNAC Standards for labelling and handling.
Vascular Prosthesis and Reconstruction
- Use of autologous veins (saphenous vein) or prosthetic grafts to restore circulation.
- Vascular patches, such as bovine pericardial patches, may be utilized for repairs.
Specific Surgical Procedures
- Aortic Aneurysm Resection involves synthetic prosthesis insertion for distal perfusion.
- Endovascular Abdominal Aortic Aneurysm Repair utilizes endoscopic techniques for aneurysm repair.
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Description
This quiz covers essential aspects of anaesthesia and patient care during cardiac procedures, focusing on general anaesthesia techniques, patient positioning, and necessary surgical instruments. It emphasizes the importance of monitoring and preparation for complications during surgery, including blood product management and adherence to safety standards.
