Peripheral Vascular Disease and Anesthesia Quiz

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Questions and Answers

Which type of anesthesia is considered a 'safer choice' than neuraxial anesthesia for peripheral vascular surgery?

General anesthesia

Peripheral nerve blocks (correct)

Spinal anesthesia

Epidural anesthesia

Why is regional anesthesia often thought to be a superior choice than general anesthesia for peripheral vascular surgery in patients with severe pulmonary disease?

It doesn't provide direct route for bronchodilator administration

It poses less risk of bronchospasm (correct)

It requires airway instrumentation

It involves the use of neuromuscular blocking agents

Which of the following is a reason NOT to use regional or neuraxial anesthesia in vascular surgery according to the text?

Catheters placed with a block

Anticoagulant/antiplatelet therapies (correct)

Local infection

Previous spine surgery with hardware

What is one potential complication that can result from epidural/spinal hematoma during peripheral vascular surgery?

Permanent neurologic injury Signup and view all the answers

What is the argument for using intubation in peripheral vascular surgery despite regional anesthesia being considered a safer choice?

For better airway control Signup and view all the answers

What is the recommended dose of Heparin in Fem Pop or Femoral to Popliteal Artery Bypass Surgery?

100 units/kg Signup and view all the answers

What is the purpose of repeating the dose of Heparin in Fem-Fem Bypass or Femoral to Femoral Bypass Surgery?

To maintain the effect of Heparin Signup and view all the answers

Why is it important to avoid hypotension in Fem Pop or Femoral to Popliteal Artery Bypass Surgery?

To prevent graft occlusion Signup and view all the answers

What is the recommended dose of Protamine at the end of Fem Pop or Femoral to Popliteal Artery Bypass Surgery?

25-50 mg Signup and view all the answers

Why is it important to check potassium levels preoperatively in AV Fistula surgery?

To prevent hyperkalemia Signup and view all the answers

What is the duration of AV Fistula surgery?

1-2 hours Signup and view all the answers

Which is NOT listed as a risk factor for atherosclerosis in patients with peripheral artery disease?

Female gender Signup and view all the answers

What is the most common site of atherosclerotic involvement below the inguinal artery?

Superficial femoral artery Signup and view all the answers

What is the main symptom that can result from fibromuscular dysplasia affecting blood vessels?

Headache Signup and view all the answers

Which of the following is NOT among the risk factors for peripheral vascular disease?

Hyperthyroidism Signup and view all the answers

In peripheral vascular disease, blood flow to organs can be affected as a result of:

Progressive twisting of blood vessels Signup and view all the answers

Which blood vessel is NOT commonly affected by atherosclerosis in peripheral artery disease?

Coronary artery Signup and view all the answers

What is the main treatment approach for managing complications of Peripheral Vascular Disease?

Procedures to open up the blood vessels Signup and view all the answers

How does regional anesthesia differ from general anesthesia in terms of the postoperative hypercoagulable state?

It attenuates the hypercoagulable state Signup and view all the answers

Which condition is characterized by an inflammation in the blood vessels, particularly in the temples?

Giant Cell Arteritis Signup and view all the answers

How does regional anesthesia potentially affect lower extremity blood flow in vascular patients?

It increases lower extremity blood flow Signup and view all the answers

What is a common symptom of Giant Cell Arteritis?

Vision changes Signup and view all the answers

In studies involving over 1300 patients, what did they find regarding cardiac morbidity and mortality when comparing regional/neuraxial anesthesia with general anesthesia?

No overall difference in cardiac morbidity and mortality Signup and view all the answers

In which artery does Adventitial Cystic Disease commonly form a cyst filled with a mucus-like substance?

Popliteal artery Signup and view all the answers

According to the current recommendation mentioned in the text, what is the most important factor in improving postoperative outcomes?

Overall optimization of perioperative care Signup and view all the answers

What is another name for Buerger's Disease?

Thromboangiitis obliterans Signup and view all the answers

Which anesthesia type is believed to have an advantage over the other in vascular patients according to the proposed mechanism mentioned in the text?

Regional anesthesia Signup and view all the answers

Which disease affects blood vessels, most commonly in the arms and legs?

Buerger's Disease Signup and view all the answers

What is the emphasis of the text regarding the choice of anesthesia for a procedure?

The provider's level of experience with the anesthesia Signup and view all the answers

Study Notes

Anesthesia Choices in Vascular Surgery

Regional anesthesia is often deemed a safer option than neuraxial anesthesia for peripheral vascular surgery due to lower risks of complications.
In patients with severe pulmonary disease, regional anesthesia is preferred over general anesthesia as it minimizes respiratory compromise and reduces lung function impairments.

Contraindications and Complications

A reason NOT to utilize regional or neuraxial anesthesia in vascular surgery includes the presence of coagulopathy or anticoagulant therapy, which increases hemorrhage risk.
A potential complication from epidural or spinal hematoma during peripheral vascular surgery is paralysis, which can severely impact recovery and mobility.

Intubation Considerations

The argument for intubation during peripheral vascular surgery, even with regional anesthesia, is to ensure airway protection and allow for controlled ventilation in case of emergencies.

Heparin and Protamine Dosing

The recommended dose of Heparin for Femoral to Popliteal Artery Bypass Surgery is typically between 80 to 100 units/kg, maintaining activated clotting time within a specific therapeutic range.
Repeating the dose of Heparin during Fem-Fem Bypass or Femoral to Femoral Bypass Surgery helps maintain adequate anticoagulation throughout the procedure.
It is crucial to avoid hypotension during Fem Pop or Femoral to Popliteal Artery Bypass Surgery as it can lead to reduced perfusion and increased risk of graft failure.

Postoperative Management

The recommended dose of Protamine at the conclusion of Fem Pop or Femoral to Popliteal Artery Bypass Surgery is usually half the total administered Heparin dose, carefully monitoring for hemostatic restoration.
Checking potassium levels preoperatively in AV Fistula surgery is vital to prevent cardiac complications related to hyperkalemia during the procedure.
The average duration of AV Fistula surgery is approximately 1 to 2 hours, depending on the complexity of the case.

Atherosclerosis and Vascular Disease

The most common site of atherosclerotic change below the inguinal artery is the superficial femoral artery, frequently involved in peripheral artery disease.
Fibromuscular dysplasia primarily presents with symptoms such as hypertension or claudication, due to impaired blood flow through affected vessels.
Non-listed risk factors for peripheral vascular disease do not typically include high levels of physical activity, which may actually aid in cardiovascular health.

Blood Flow Impact and Treatment

In peripheral vascular disease, blood flow to vital organs can be compromised due to arterial blockages, leading to ischemic symptoms.
Affected blood vessels in atherosclerotic conditions notably exclude the mesenteric arteries, which are less commonly impacted.
The main treatment approach for addressing complications of Peripheral Vascular Disease focuses on optimizing blood flow and managing risk factors.

Regional vs General Anesthesia

Regional anesthesia may mitigate the risks associated with a hypercoagulable state postpartum, reducing the likelihood of thromboembolic events compared to general anesthesia.
Giant Cell Arteritis is characterized by inflammation of blood vessels, often presenting with headache and jaw claudication.
Studies with over 1300 patients indicated reduced cardiac morbidity and mortality when utilizing regional or neuraxial anesthesia in comparison with general anesthesia.

Additional Conditions and Anesthesia Emphasis

Adventitial Cystic Disease commonly presents in the popliteal artery, forming cysts that can obstruct blood flow.
Improving postoperative outcomes hinges significantly on ensuring patient safety and tailoring anesthesia to individual risk factors.
Another name for Buerger's Disease is Thromboangiitis Obliterans, which predominantly affects blood vessels in the limbs.
The choice of anesthesia for vascular procedures must consider patient-specific factors, emphasizing the importance of individualized medical care.

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Description

Test your knowledge on the causes and impact of peripheral vascular disease on the anesthetic plan, differentiate between acute and chronic PVD, and identify disease states associated with peripheral vascular conditions.