Anesthetic Goals and Techniques in EVAR

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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?

Patient's age Signup and view all the answers

How long can an EVAR procedure typically take?

Between 4 and 12 hours Signup and view all the answers

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

ACC/AHA Signup and view all the answers

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

Risk of major hemorrhage Signup and view all the answers

Why is thorough preoperative assessment crucial for patients undergoing EVAR?

To identify patients with major comorbidities Signup and view all the answers

What is essential for a successful EVAR procedure?

Good teamwork and communication Signup and view all the answers

What should CRNAs consider when evaluating the complexity of EVAR?

The distinction between simple infra-renal EVAR and complex supra-renal EVAR Signup and view all the answers

What is the importance of multidisciplinary settings in EVAR?

To facilitate preoperative assessment and optimization Signup and view all the answers

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

To maintain normothermia for early extubation Signup and view all the answers

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

To provide an alternative to internal paddles during surgery Signup and view all the answers

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

Due to the collapse of the lung during one-lung ventilation 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?

To prevent damage to surrounding vessels during line insertion 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?

To provide SVC drainage during surgery involving the right atrium Signup and view all the answers

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

4 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?

10 000u of heparin Signup and view all the answers

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

To facilitate adequate visualisation of the surgical site Signup and view all the answers

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

10 mmHg Signup and view all the answers

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

Ensuring the cannula is smaller in diameter than the femoral artery Signup and view all the answers

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

Immediate conversion to full sternotomy Signup and view all the answers

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

Conversion to normal bilateral lung ventilation Signup and view all the answers

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

Telemanipulation Signup and view all the answers

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

Advanced skills in TEE Signup and view all the answers

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

Reducing the need for general anaesthesia Signup and view all the answers

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

2-15% Signup and view all the answers

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

To evaluate the effects of regional anesthesia techniques on perioperative cardiac morbidity and overall mortality in patients undergoing peripheral vascular surgery Signup and view all the answers

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

The type of anesthesia does not significantly affect cardiac morbidity or mortality, overall mortality, or hospital length of stay 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?

4 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?

The findings remain valid regardless of the analysis method 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?

1.0 ug-kg*min' 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?

The patients underwent lower extremity peripheral vascular surgery, which is associated with less intense postoperative pain 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?

The patients underwent lower extremity peripheral vascular surgery, which is associated with less intense postoperative pain Signup and view all the answers

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

It may not detect small myocardial infarctions associated with limb ischemia 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?

It is at the lower end of the range reported in other similar studies Signup and view all the answers

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

It does not affect the incidence of cardiac morbidity and mortality Signup and view all the answers

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

It suggests that the incidence of cardiovascular morbidity and mortality is similar regardless of the type of anesthesia used Signup and view all the answers

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

To improve the patients' hemodynamic status intraoperatively and for the first 48 hours after surgery Signup and view all the answers

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

It is a relatively insensitive monitor for detecting myocardial ischemia 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?

It suggests that the patient population is at high risk for cardiac morbidity and mortality Signup and view all the answers

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

It decreases the incidence of cardiac morbidity and mortality Signup and view all the answers

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

It suggests that a multi-faceted approach is necessary to manage perioperative cardiac morbidity and mortality Signup and view all the answers

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

To demonstrate the clinical applicability of dual closed-loop systems in major vascular surgery Signup and view all the answers

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

They are higher than the hand-titrated results reported by Puri et al Signup and view all the answers

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

The complexity of the vascular surgeries Signup and view all the answers

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

The previous publications Signup and view all the answers

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

It is lower than the total duration of anesthesia Signup and view all the answers

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

The risk level of the patients Signup and view all the answers

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

To determine if they would interact during periods of hemodynamic instability Signup and view all the answers