Anaesthetic Management of Cardiac Surgery
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Questions and Answers

What is the primary goal of anxiolytic and sedation in premedication?

  • To reduce anxiety and promote relaxation (correct)
  • To decrease secretion
  • To facilitate induction of anesthesia
  • To decrease gastric volume

    • What is the purpose of antibiotics in premedication?

  • To facilitate induction of anesthesia
  • To provide anti-infective prophylaxis (correct)
  • To decrease gastric volume
  • To reduce anxiety and promote relaxation

    • What is the primary objective of preoperative preparation in anaesthetic management of cardiac surgery?

  • To evaluate the patient's medical history and current health status (correct)
  • To develop a standardized anaesthetic technique for all patients
  • To minimize the risk of complications during surgery
  • To discuss the anaesthetic management plan with the surgeon

    • What is the minimum hemoglobin level required for a healthy patient undergoing cardiac surgery?

    <p>10g/Dl</p> Signup and view all the answers

    What should be prepared before the arrival of the patient in the anesthesia or operating room?

    <p>All the anesthesia drugs, heparin, antibiotics, and cardiovascular drugs</p> Signup and view all the answers

    Which of the following laboratory tests is not typically included in preoperative preparation for cardiac surgery?

    <p>Magnetic Resonance Imaging (MRI)</p> Signup and view all the answers

    Why should a permanent pacemaker be programmed to a non-sensing mode before induction of anesthesia?

    <p>To prevent diathermy from inhibiting the pacemaker's discharge</p> Signup and view all the answers

    What is the goal of induction during intraoperative management?

    <p>Hemodynamic stability</p> Signup and view all the answers

    What is the purpose of the informed consent process in preoperative preparation?

    <p>To discuss the anaesthetic management plan and potential complications</p> Signup and view all the answers

    What is the objective of hemodynamic stability in premedication?

    <p>To maintain a stable heart rate and blood pressure</p> Signup and view all the answers

    Why is N2O avoided during maintenance of anesthesia?

    <p>It causes expansion of intravascular air bubbles and pneumothorax</p> Signup and view all the answers

    What is the purpose of describing the anesthetic technique to the patient?

    <p>To inform the patient of the risks involved</p> Signup and view all the answers

    What is the purpose of using a urinary catheter during intraoperative management?

    <p>To measure urine output and bladder temperature</p> Signup and view all the answers

    How many hours before surgery should an adult patient fast from solid food?

    <p>6-8 hours</p> Signup and view all the answers

    What is the role of antiemetic in premedication?

    <p>To prevent nausea and vomiting</p> Signup and view all the answers

    Why is anticoagulation necessary before CPB?

    <p>To reduce the risk of thrombosis</p> Signup and view all the answers

    Which of the following is a specific test used in pulmonary evaluation for cardiac surgery?

    <p>Lung Function Test</p> Signup and view all the answers

    What is the minimum duration of fasting required for breast milk before cardiac surgery in children?

    <p>4 hours</p> Signup and view all the answers

    What is the primary function of CPB?

    <p>To divert venous blood away from the heart and add oxygen, remove CO2, and return the blood to a large artery</p> Signup and view all the answers

    What should be prepared before the start of surgery if the patient has a pacemaker?

    <p>The pacemaker should be programmed to a non-sensing mode</p> Signup and view all the answers

    Which of the following is not an objective of anaesthetic management of cardiac surgery?

    <p>Surgical technique</p> Signup and view all the answers

    What is the goal of maintenance of anesthesia?

    <p>To achieve early extubation</p> Signup and view all the answers

    What is the purpose of using vasopressors during maintenance of anesthesia?

    <p>To treat hypotension if blood pressure falls &gt;20%</p> Signup and view all the answers

    What type of anesthetic technique is used during maintenance of anesthesia?

    <p>Total intravenous anesthesia (TIVA) with short-acting agents</p> Signup and view all the answers

    What is the temperature achieved during cardiopulmonary bypass?

    <p>Hypothermia</p> Signup and view all the answers

    What is the purpose of administering a 'Hot Shot' or warm blood cardioplegia during cardiopulmonary bypass?

    <p>To wash out byproducts and replenish metabolic substrates</p> Signup and view all the answers

    What is the desired range of activated clotting time (ACT) during cardiopulmonary bypass?

    <p>400-500 sec</p> Signup and view all the answers

    What is the primary purpose of cardioplegia during cardiopulmonary bypass?

    <p>To protect the heart from ischemia</p> Signup and view all the answers

    What is the recommended hematocrit range during cardiopulmonary bypass?

    <p>20-25%</p> Signup and view all the answers

    What is the primary complication associated with aortic cannulation?

    <p>Aortic dissection</p> Signup and view all the answers

    What is the purpose of reducing systemic arterial pressure during cardiopulmonary bypass?

    <p>To reduce the risk of aortic dissection and cerebral embolism</p> Signup and view all the answers

    What is the recommended range of mean arterial pressure (MAP) during cardiopulmonary bypass?

    <p>50-80 mmHg</p> Signup and view all the answers

    What is the primary mechanism of action of protamine in reversing anticoagulation?

    <p>Neutralizing heparin activity</p> Signup and view all the answers

    What is a potential complication of re-expansion of the lungs during weaning from CPB?

    <p>Pneumothorax</p> Signup and view all the answers

    What is the primary goal of securing haemostasis during the off-pump stage?

    <p>Preventing bleeding complications</p> Signup and view all the answers

    What is the recommended dose of protamine to reverse heparin activity?

    <p>1 mg per mg of heparin</p> Signup and view all the answers

    What is a common cause of hypoxia during weaning from CPB?

    <p>Inadequate re-expansion of the lungs</p> Signup and view all the answers

    What is the purpose of checking ACT during protamine administration?

    <p>To assess heparin activity</p> Signup and view all the answers

    What is a potential side effect of protamine administration?

    <p>Hypotension</p> Signup and view all the answers

    What is the minimum required monitoring during transfer to the ICU?

    <p>Direct measurement of SAP and ECG</p> Signup and view all the answers

    Study Notes

    Anaesthetic Management of Cardiac Surgery

    • Anaesthesia for cardiac surgery involves a standardized technique with adaptations to individual patient pathology
    • Objectives:
    • Preoperative preparation
    • Intraoperative management
    • Postoperative management

    Preoperative Preparation

    • History: medical, surgical, drug, and previous anaesthesia history
    • Examination: cardiovascular, respiratory, spine and vertebra, and airway assessment
    • Investigations:
    • Laboratory data: CBC, blood chemistry, CXR, urinalysis, pregnancy test, and ECG
    • Specific tests: cardiac evaluation (exercise stress test, thallium scan, echocardiogram), pulmonary evaluation (lung function test, spirometry, arterial blood gas), and vascular evaluation (lower limb Doppler, carotid Doppler)
    • Consent form: informed consent, including discussion of anaesthetic management plan, alternatives, potential complications, and NPO guidelines
    • Premedication:
    • Objectives: anxiolysis, sedation, analgesia, amnesia, haemodynamic stability, decreased secretion, decreased gastric volume, antiemesis, and facilitation of anaesthesia induction
    • Medications: benzodiazepines, butyrophenones, opioids, aspiration prevention, antiemetics, and antibiotics
    • Psychological support: description of anaesthetic technique, risk, and duration

    Preparation for Induction of Anaesthesia

    • Pre-arrival preparation: preparation of the operating room, staff, and anaesthetic drugs before the patient's arrival
    • Pacemakers and automatic implantable cardioverter/defibrillators: programming to a non-sensing mode or a suitable high rate before induction of anaesthesia

    Intraoperative Management

    • Monitoring:
    • Indwelling urinary catheter
    • Temperature probes (esophageal, nasopharyngeal, skin, bladder, and tympanic)
    • Cross-matched blood available
    • Consideration of thoracic epidural anaesthesia (in Europe)
    • Induction:
    • Goal: haemodynamic stability
    • Selection of induction agents: high-dose opiates, benzodiazepines, modest dose of IV anaesthetic agents, muscle relaxants, and vasopressors
    • Maintenance of anaesthesia:
    • Selection of anaesthetic technique/agents: TIVA with short-acting agents, volatile anaesthetic agents, and avoidance of N2O
    • High-dose opiates, muscle relaxants, and vasopressors
    • Goal: early extubation (1-6 hours post-op) and fast-track
    • Cardiopulmonary bypass:
    • CPB diverts venous blood away from the heart, adds oxygen, removes CO2, and returns blood to a large artery
    • Organ protection: hypothermia, cardioplegia, and organ perfusion
    • Complications: aortic dissection, cerebral embolism, and activation of multiple humoral systems

    Cardiopulmonary Bypass

    • Initiation of CPB: associated with a marked increase in stress hormones, systemic inflammatory response, and activation of multiple humoral systems
    • Intraoperative laboratory monitoring:
    • Blood gas analysis (point of care)
    • Activated clotting time (ACT)
    • Weaning from CPB:
    • Preparation: "hot shot" or warm blood cardioplegia, optimization of physiological conditions, and normovolemia
    • Weaning: reopening of the aorta, re-start of pulmonary ventilation, and gradual reduction of CPB flow

    Weaning Problems

    • Poor cardiac function: inotropic support, reperfusion, and afterload reduction
    • Residual air problem: evacuation of air from the heart and bypass grafts
    • Hypoxia: detection and treatment of pulmonary oedema, shunting through a septal defect

    Reversal of Anticoagulation

    • Protamine: binds and inactivates heparin, dose, and side-effects
    • Monitoring: ACT, haemodynamic side-effects, and supplemental protamine

    Off Pump and Transfer to Critical Care Unit

    • Securing haemostasis and chest closure
    • Transfer to ICU: vulnerable period, direct measurement of SAP and ECG, pulse oximetry for hypoxia detection

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    Anesthesia for cardiac surgery.pptx

    Description

    This quiz covers the standardized anaesthetic technique used in cardiac surgery, including adapting to patient pathology. Learn about the objectives and techniques involved in anaesthetic management.

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