Anaesthesia in Cardiac Surgery

Questions and Answers

What is the primary purpose of providing general anaesthesia with endotracheal tube (ETT) during cardiac surgeries?

To prevent excessive bleeding during surgery

To ensure the patient remains unconscious during the procedure (correct)

To eliminate the risk of infection

To facilitate rapid recovery from anesthesia

Which factors are critical during the period of anaesthesia induction?

Administering local anaesthesia to minimize discomfort

Confirming the patient's medical history

Providing postoperative care to the patient

Presence of the entire surgical team and monitoring for ventricular ischemia (correct)

What is the standard patient positioning for cardiac surgeries requiring a median sternotomy?

Prone position

Lateral position

Supine position (correct)

Sitting position

Which suture is commonly used for anastomosis in vascular repairs during cardiac procedures?

Surgipro or Prolene sutures Signup and view all the answers

What is a major count in cardiac surgeries?

The count of major instruments at the beginning and closure of a surgery Signup and view all the answers

What is the role of cardiopulmonary bypass (CPB) during cardiac surgery?

To temporarily manage blood flow and oxygenation Signup and view all the answers

Why is it essential to have orders and availability of blood products confirmed before cardiac surgery?

To ensure that there are adequate supplies for any unexpected blood loss Signup and view all the answers

Which of the following instruments is NOT considered a common cardiac surgical instrument?

Harmonic scalpel Signup and view all the answers

What is the primary goal during cardiovascular emergency aneurysm repair?

To clamp the ruptured aneurysm as soon as possible Signup and view all the answers

Which of the following materials is NOT typically used for securing stents in an endograft procedure?

No sutures are needed Signup and view all the answers

What must the circulating and scrub nurses confirm before implantation of a prosthetic graft?

Graft type, size, expiry date, and preparation requirements Signup and view all the answers

In a femoral-popliteal bypass in situ, what happens to the saphenous vein?

It remains in its natural location, and the valves are removed Signup and view all the answers

What equipment is essential on the sterile table for a cardiovascular aneurysm repair procedure?

Aortic cross clamps, sponges, and suction Signup and view all the answers

Which method of grafting does NOT involve removing the saphenous vein from its natural location?

Femoral-popliteal bypass in situ Signup and view all the answers

What is a crucial step when preparing for a risk of converting to an open procedure?

Have instrumentation and supplies ready Signup and view all the answers

In permanent pacemaker insertion, what is the method of introduction for the leads?

Through the subclavian vein into the heart chamber Signup and view all the answers

What is the primary advantage of using the Left Internal Mammary Artery (LIMA) as a graft over a saphenous vein?

It is accustomed to higher pressure blood flow. Signup and view all the answers

Which of the following procedural considerations is not associated with valve repair or replacement?

Conduit harvest Signup and view all the answers

When preparing for a valve replacement, what must the perioperative nurse confirm?

The type of valve the surgeon will use. Signup and view all the answers

What complication is associated with valve regurgitation?

Blood flows back into the ventricle. Signup and view all the answers

Which of the following is a method of arterial grafting mentioned?

In situ arterial grafts Signup and view all the answers

What type of valve requires a patient to be placed on long-term anticoagulation therapy?

Mechanical valve Signup and view all the answers

Which procedural step is essential before closing the sternum after a bypass procedure?

Distal anastomosis completion Signup and view all the answers

What condition necessitates valve repair or replacement in cardiovascular surgery?

Valvular stenosis Signup and view all the answers

What is the main purpose of the pulse generator in bradydysrhythmias?

To initiate atrial or ventricular contraction. Signup and view all the answers

Which procedural step is emphasized for both pulse generator and ICD insertions?

Strict aseptic technique must be followed. Signup and view all the answers

What typically occurs in the operating room during an ICD insertion procedure?

Defibrillator shocks may be tested after incision closure. Signup and view all the answers

What must be confirmed prior to implanting an ICD?

Type, size, expiry date, and preparation requirements of the implant. Signup and view all the answers

Which of the following is a similarity between ICDs and permanent pacemakers?

Both involve similar procedural steps for insertion. Signup and view all the answers

What safety measure is taken during the testing of an ICD in the operating room?

Defibrillator pads or paddles with a compatible external defibrillator must be available. Signup and view all the answers

What is not typically a part of the ICD insertion procedure?

Administering sedatives before the procedure. Signup and view all the answers

During the insertion of a pulse generator, what is the expected duration of the procedure?

One hour. Signup and view all the answers

What characteristic distinguishes arteries from veins?

Arteries can contract and constrict to stop bleeding. Signup and view all the answers

Which of the following statements about veins is correct?

Veins contain valves to prevent blood backflow. Signup and view all the answers

What is the primary purpose of heparinized saline in vascular surgery?

To irrigate during cross clamping of the vessel. Signup and view all the answers

Which statement about the tunica media is correct?

It comprises the muscular middle layer. Signup and view all the answers

What type of disease may lead to a diagnosis of acute arterial insufficiency?

Atherosclerosis. Signup and view all the answers

Which medication is used as a vasodilator in vascular surgery?

Papavarine. Signup and view all the answers

What is a common symptom displayed by patients with vascular disease?

Cerebrovascular disease symptoms. Signup and view all the answers

What is the role of absorbable gelatin sponge in vascular surgery?

To promote adhesion of platelets. Signup and view all the answers

Study Notes

Anaesthesia Considerations

General anaesthesia with endotracheal tube (ETT) required for ACB or valve surgeries.
Induction phase is critical for monitoring, especially in patients with ventricular ischemia.
Presence of the entire surgical team is essential during anaesthesia induction.
Blood replacement may be necessary due to extensive tissue dissection; confirm blood product availability at all stages.

Patient Positioning and Surgical Preparation

Median sternotomy is performed for valve replacement or ACB procedures.
Patients are positioned supine to optimize surgical exposure.
Reference the ORNAC Standards and positioning checklist for best practices.

Common Cardiac Instruments

Key instruments include Potts scissors, Castroviejo needle holders, Ryder needle holders, and various clamps.
Saphenous vein grafts are often used in ACBs, which can be harvested using minimally invasive techniques.
Endoscopic instruments such as camera and endoscopic scissors are employed for certain procedures.

Cardiopulmonary Bypass (CPB)

CPB acts as a temporary substitute for the heart and lungs by diverting blood flow during surgery.
This technique allows for a still and bloodless surgical field.

Grafting Techniques

LIMA (Left Internal Mammary Artery) and RIMA (Right Internal Mammary Artery) are preferred for grafting due to their durability compared to saphenous veins.
Saphenous veins are less durable and under lower pressure than arteries.

Valve Repair/Replacement

Indications for procedure include stenosis and regurgitation.
The type of valve (mechanical or bioprosthesis) impacts postoperative care, particularly regarding anticoagulation therapy.

Structure of Vascular System

Arteries: thicker walls, more elastic, capable of contraction; carry blood away from the heart.
Veins: thinner walls, contain valves to prevent backflow; carry blood toward the heart.

Vascular Disease and Surgical Considerations

Patients may have aortic aneurysms or chronic arterial insufficiency.
Topical hemostatic agents and medications (e.g., heparinized saline, papavarine) play critical roles in surgery.

Emergency Aneurysm Repair

Immediate clamping of a ruptured aneurysm is crucial; counts might be skipped in urgent situations.
Key instruments and supplies must be prepared and readily available.

Femoral Popliteal Bypass

Can be performed using the patient’s own vein or a prosthetic graft to restore leg blood flow.
In situ procedures involve using the saphenous vein without removal, necessitating the removal of valves.

Pacemaker Insertion

Electrodes are placed through the subclavian vein to facilitate heart chamber connection; pulse generators are implanted subcutaneously.
Strict aseptic technique must be followed to prevent infection.

Implantable Cardioverter Defibrillator (ICD) Insertion

ICDs monitor electrical activity and deliver shocks for ventricular tachycardia or fibrillation.
Similar protocols to pacemaker insertion, but with additional capability for pacing and defibrillation; require strict aseptic technique.

Key Procedural Considerations

Documentation of implant type and patient details is essential for all surgical procedures.
Continuous monitoring and preparation by surgical staff are crucial throughout cardiovascular surgeries.

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Description

This quiz focuses on the critical role of anaesthesia in patients undergoing ACB or valve surgeries. It covers the importance of monitoring left ventricular function and the necessity for a complete surgical team during anaesthesia induction. Test your knowledge on the principles and practices involved in anaesthesia management for cardiac procedures.