Anesthetic Goals and Techniques in EVAR
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Questions and Answers

What is one of the main goals of intraoperative anesthetic management in EVAR?

  • To maintain intravascular volume
  • To induce neuromuscular blockade
  • To provide hemodynamic stability (correct)
  • To provide normothermia

What is the current limitation in selecting the best anesthesia for standard EVAR?

  • Limited availability of qualified anesthesiologists
  • Limited evidence from retrospective studies (correct)
  • Lack of standardization in anesthetic techniques
  • Insufficient number of patients for research

Why is general anesthesia often preferred over regional anesthesia for EVAR?

  • To reduce the risk of cardiac complications
  • Because of the need for arterial access from multiple sites (correct)
  • Due to the complexity of the aneurysm
  • To ensure patient comfort during the long procedure

What is NOT a consideration in selecting an anesthetic technique for EVAR?

<p>Patient's age (C)</p> Signup and view all the answers

How long can an EVAR procedure typically take?

<p>Between 4 and 12 hours (A)</p> Signup and view all the answers

What organization does NOT advocate for a specific mode of anesthesia for patients with cardiac disease?

<p>ACC/AHA (D)</p> Signup and view all the answers

What is a key consideration for CRNAs when preparing for EVAR?

<p>Risk of major hemorrhage (B)</p> Signup and view all the answers

Why is thorough preoperative assessment crucial for patients undergoing EVAR?

<p>To identify patients with major comorbidities (C)</p> Signup and view all the answers

What is essential for a successful EVAR procedure?

<p>Good teamwork and communication (C)</p> Signup and view all the answers

What should CRNAs consider when evaluating the complexity of EVAR?

<p>The distinction between simple infra-renal EVAR and complex supra-renal EVAR (B)</p> Signup and view all the answers

What is the importance of multidisciplinary settings in EVAR?

<p>To facilitate preoperative assessment and optimization (C)</p> Signup and view all the answers

What is the primary reason for having warming devices available during minimally invasive cardiac surgery?

<p>To maintain normothermia for early extubation (C)</p> Signup and view all the answers

What is the purpose of attaching external defibrillator pads during minimally invasive cardiac surgery?

<p>To provide an alternative to internal paddles during surgery (B)</p> Signup and view all the answers

Why may the thoracic impedance be too high during one-lung ventilation in minimally invasive cardiac surgery?

<p>Due to the collapse of the lung during one-lung ventilation (B)</p> Signup and view all the answers

What is the purpose of confirming the vascular access sites prior to the insertion of invasive lines in minimally invasive cardiac surgery?

<p>To prevent damage to surrounding vessels during line insertion (C)</p> Signup and view all the answers

What is the purpose of inserting a large bore right internal jugular venous cannula in minimally invasive cardiac surgery?

<p>To provide SVC drainage during surgery involving the right atrium (B)</p> Signup and view all the answers

What is the minimum number of pressure transducers required for standard cardiac surgery monitoring?

<p>4 (B)</p> Signup and view all the answers

What should be administered before the insertion of a double-lumen tube or a single-lumen tube with a bronchial blocker?

<p>10 000u of heparin (B)</p> Signup and view all the answers

What is the primary purpose of intra-thoracic insufflation of CO2?

<p>To facilitate adequate visualisation of the surgical site (B)</p> Signup and view all the answers

What is the recommended maximal insufflation pressure to avoid a decrease in venous return and cardiac output?

<p>10 mmHg (A)</p> Signup and view all the answers

What is the primary consideration when inserting an aortic cannula under ultrasound guidance?

<p>Ensuring the cannula is smaller in diameter than the femoral artery (B)</p> Signup and view all the answers

What is a potential complication of aortic rupture, dissection, or intimal tears during MICS?

<p>Immediate conversion to full sternotomy (B)</p> Signup and view all the answers

What is the recommended course of action in the event of hypoxaemia during MICS for valvular lesions?

<p>Conversion to normal bilateral lung ventilation (D)</p> Signup and view all the answers

What is the primary advantage of the Da Vinci robotic system?

<p>Telemanipulation (D)</p> Signup and view all the answers

What is a key requirement for anaesthesiologists performing robotic-assisted cardiac surgery?

<p>Advanced skills in TEE (D)</p> Signup and view all the answers

What is the primary advantage of regional blocks for thoracic incisions?

<p>Reducing the need for general anaesthesia (D)</p> Signup and view all the answers

What is the estimated conversion rate to full sternotomy from a minimally invasive approach?

<p>2-15% (C)</p> Signup and view all the answers

What is the primary objective of the largest prospective randomized trial to date?

<p>To evaluate the effects of regional anesthesia techniques on perioperative cardiac morbidity and overall mortality in patients undergoing peripheral vascular surgery (B)</p> Signup and view all the answers

What is the conclusion of the study regarding the type of anesthesia given for peripheral vascular surgery?

<p>The type of anesthesia does not significantly affect cardiac morbidity or mortality, overall mortality, or hospital length of stay (B)</p> Signup and view all the answers

How many previous studies have examined the superiority of regional anesthesia over general anesthesia in reducing perioperative complications in patients undergoing peripheral vascular surgery?

<p>4 (C)</p> Signup and view all the answers

What is the significance of the study's findings on the analysis of data by intention to treat or by type of anesthesia received?

<p>The findings remain valid regardless of the analysis method (A)</p> Signup and view all the answers

What is the minimum dose of intravenous nitroglycerin required to reduce episodes of ischemia in high-risk patients undergoing cardiac surgery?

<p>1.0 ug-kg*min' (C)</p> Signup and view all the answers

What is a possible explanation for the lack of significant difference in cardiac morbidity or mortality between the epidural group and the parenteral opioids group?

<p>The patients underwent lower extremity peripheral vascular surgery, which is associated with less intense postoperative pain (B)</p> Signup and view all the answers

What is a potential reason for the lack of significant difference in cardiac morbidity or mortality between the epidural group and the parenteral opioids group?

<p>The patients underwent lower extremity peripheral vascular surgery, which is associated with less intense postoperative pain (A)</p> Signup and view all the answers

What is the limitation of using CK-MB fraction analysis in diagnosing perioperative myocardial infarction?

<p>It may not detect small myocardial infarctions associated with limb ischemia (C)</p> Signup and view all the answers

What is the significance of the study's finding of a 4.5% incidence of myocardial infarction using CK-MB fraction analysis?

<p>It is at the lower end of the range reported in other similar studies (C)</p> Signup and view all the answers

What is the potential effect of sympathetic blockade and resulting venodilation caused by spinal and epidural anesthesia?

<p>It does not affect the incidence of cardiac morbidity and mortality (C)</p> Signup and view all the answers

What is the significance of the study's findings in the context of perioperative cardiac morbidity and mortality?

<p>It suggests that the incidence of cardiovascular morbidity and mortality is similar regardless of the type of anesthesia used (D)</p> Signup and view all the answers

What is the primary reason for the use of pulmonary artery catheter monitoring in the study?

<p>To improve the patients' hemodynamic status intraoperatively and for the first 48 hours after surgery (B)</p> Signup and view all the answers

What is the potential limitation of using pulmonary artery catheter monitoring in high-risk patients?

<p>It is a relatively insensitive monitor for detecting myocardial ischemia (C)</p> Signup and view all the answers

What is the significance of the study's findings in the context of clinical characteristics of the patient population?

<p>It suggests that the patient population is at high risk for cardiac morbidity and mortality (B)</p> Signup and view all the answers

What is the potential effect of the use of prophylactic nitroglycerin in the study population?

<p>It decreases the incidence of cardiac morbidity and mortality (C)</p> Signup and view all the answers

What is the implication of the study's findings on the management of perioperative cardiac morbidity and mortality?

<p>It suggests that a multi-faceted approach is necessary to manage perioperative cardiac morbidity and mortality (B)</p> Signup and view all the answers

What is the main objective of the dual closed-loop systems used in the pilot study?

<p>To demonstrate the clinical applicability of dual closed-loop systems in major vascular surgery (A)</p> Signup and view all the answers

What is the significance of the median cohort times reported in the study?

<p>They are higher than the hand-titrated results reported by Puri et al (C)</p> Signup and view all the answers

What is the possible reason for the lower per-patient rate of time in BIS target 40-60?

<p>The complexity of the vascular surgeries (C)</p> Signup and view all the answers

What is the clinical performance of the fluid management controller compared to?

<p>The previous publications (D)</p> Signup and view all the answers

What is the significance of the number of episodes of burst suppression?

<p>It is lower than the total duration of anesthesia (C)</p> Signup and view all the answers

What was a key difference between the current study and previous studies by the same group?

<p>The risk level of the patients (B)</p> Signup and view all the answers

What was the aim of the study in terms of the interaction between the two controllers?

<p>To determine if they would interact during periods of hemodynamic instability (A)</p> Signup and view all the answers
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