Introduction to Cardiac Anesthesia PDF

Introduction to Cardiac Anesthesia Emilie Gardner CRNA, DNAP, APRN Department of Anesthesiology Inova Fairfax Hospital Northstar Anesthesia Objectives Discuss key concepts and principles related to cardiovascular anatomy and physiology and the anesthetic ma...

Introduction to Cardiac Anesthesia Emilie Gardner CRNA, DNAP, APRN Department of Anesthesiology Inova Fairfax Hospital Northstar Anesthesia Objectives Discuss key concepts and principles related to cardiovascular anatomy and physiology and the anesthetic management of patients requiring cardiac surgery. a. To include: i. Cardiac pre-operative testing, intraoperative monitors and vasoactive medications. ii. Cardiopulmonary bypass principles. iii. Anesthetic considerations for on and off pump myocardial revascularization. iv. Anesthetic management of valvular heart disease and valvular surgery Required textbooks: 1. Elisha S., Heiner J.S., Nagelhout, J.J. (2022). Nurse Anesthesia (7th Edition) St Louis: Saunders (ISBN: 978-0-323-71194-4) Required resources: 1. Apex Anesthesia Review Course (www.apexanesthesia.com) Recommended resources: 1. Jaffe, R., Schmiesing, C., & Golianu, B. (2020). Anesthesiologist's Manual of Surgical Procedures (6 th Edition) Wolters Kluwer: Philadelphia (ISBN: 978-1-4963-7125-6) 2. Miller RD. (2020). Anesthesia (9th Edition) Philadelphia: Elsevier. (ISBN: 978-0-323- 59604-6) 3. Butterworth, J.F., Mackey, D.C., & Wasnick, J.D. (2018). Morgan and Mikhail’s Clinical Anesthesiology. (6th Edition). New York, McGraw-Hill Education (ISBN: 9781259834424) 4. Pardo Jr., M.C. (2022). Miller’s Basics of Anesthesia. (8 th Edition). Philadelphia: Elsevier (ISBN: 9780323796774) Additional Resources: https://accrac.com/category/cardiac/ Vargo Anesthesia App STAT Pearls NCBI Bookshelf https://www.ncbi.nlm.nih.gov/books/NBK430685/ Case Scenario 60 y/o male 80kg DM2 (A1C 6.42), CHF w/ mixed NICM and ICM, PMH, CABG s/p CRT/D, recurrent VT storm , bilateral VATS sympathectomies, VT ablation Cardiogenic shock w/ Impella Heart Transplant w/ cryoablation of nerves Preoperative Considerations EKG CXR/CT Stress Test, Nuclear Imaging Cardiac Cath ECHO: valves, Chambers, function Implantable Devices & Cardiac Resynchronization Therapy Labs Medications: Beta Blockers Systemic: Diabetes, Renal Function Neuro, Carotid Studies Social Preop: EKG Significant Findings Leads involved ST-T wave changes, significant Q-waves STEMI vs NSTEMI vs unstable angina BBB and LVH Significant Arrhythmia Pacemaker/AICD Single best ECG lead for ischemia is V5 75% events o Brown V lead placed 5th ICS anterior axillary line o Combine v4 or v5 with II and use automated ST analysis Preop: ECHO LV EF (systolic dysfunction) and RV function Diastolic and Systolic dysfunction o TEE is the most sensitive intraop monitor for detecting myocardial ischemia o (acute regional wall motion abnormalities occur on echo before changes on ECG) LVH Pericardial effusion/tamponade PFO (extra concern for air right to left) Plaque on ascending aorta (difficulty cannulating or clamping) Valves: o stenosis vs regurgitant o Mild...moderate....severe o Pressure gradient across valve (observe aortic gradients in TAVR) Preop: Cardiac Cath LVEDP, cardiac index Presence of Left Main, triple vessel disease Type, location and timing of coronary stents (and related Rx) Pulmonary Hypertension Preop: Medications Antihypertensives o ACE/ARB, Beta Blockers, Diuretics, CaChannel Blockers, Dihydropyridines, Alpha Blockers, Direct Vasodilators, Renin Inhibitors Anticoagulants & Antiplatelets o Aspirin, warfarin, Plavix, Angina Diabetes Antiarrhythmics/Rate Control o Amiodarone, sotalol, flecanide, Digoxin, magnesium Perioperative Glucose Recommendations Hyperglycemia r/t increased wound infection, extended length of stay, angina, postop mortality, decreased long- term survival Health and Human Services surgical care measure assoc w/ Medicare reimbursement Preop: hold oral meds for 24 hours, hold insulin night before, continue basal insulin, check glucose preop, maintain