Questions and Answers
What is the primary goal of anxiolytic and sedation in premedication?
What is the purpose of antibiotics in premedication?
What is the primary objective of preoperative preparation in anaesthetic management of cardiac surgery?
What is the minimum hemoglobin level required for a healthy patient undergoing cardiac surgery?
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What should be prepared before the arrival of the patient in the anesthesia or operating room?
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Which of the following laboratory tests is not typically included in preoperative preparation for cardiac surgery?
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Why should a permanent pacemaker be programmed to a non-sensing mode before induction of anesthesia?
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What is the goal of induction during intraoperative management?
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What is the purpose of the informed consent process in preoperative preparation?
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What is the objective of hemodynamic stability in premedication?
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Why is N2O avoided during maintenance of anesthesia?
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What is the purpose of describing the anesthetic technique to the patient?
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What is the purpose of using a urinary catheter during intraoperative management?
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How many hours before surgery should an adult patient fast from solid food?
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What is the role of antiemetic in premedication?
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Why is anticoagulation necessary before CPB?
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Which of the following is a specific test used in pulmonary evaluation for cardiac surgery?
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What is the minimum duration of fasting required for breast milk before cardiac surgery in children?
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What is the primary function of CPB?
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What should be prepared before the start of surgery if the patient has a pacemaker?
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Which of the following is not an objective of anaesthetic management of cardiac surgery?
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What is the goal of maintenance of anesthesia?
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What is the purpose of using vasopressors during maintenance of anesthesia?
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What type of anesthetic technique is used during maintenance of anesthesia?
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What is the temperature achieved during cardiopulmonary bypass?
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What is the purpose of administering a 'Hot Shot' or warm blood cardioplegia during cardiopulmonary bypass?
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What is the desired range of activated clotting time (ACT) during cardiopulmonary bypass?
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What is the primary purpose of cardioplegia during cardiopulmonary bypass?
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What is the recommended hematocrit range during cardiopulmonary bypass?
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What is the primary complication associated with aortic cannulation?
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What is the purpose of reducing systemic arterial pressure during cardiopulmonary bypass?
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What is the recommended range of mean arterial pressure (MAP) during cardiopulmonary bypass?
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What is the primary mechanism of action of protamine in reversing anticoagulation?
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What is a potential complication of re-expansion of the lungs during weaning from CPB?
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What is the primary goal of securing haemostasis during the off-pump stage?
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What is the recommended dose of protamine to reverse heparin activity?
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What is a common cause of hypoxia during weaning from CPB?
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What is the purpose of checking ACT during protamine administration?
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What is a potential side effect of protamine administration?
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What is the minimum required monitoring during transfer to the ICU?
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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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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.
