M&m: Ch. 21 Anesthesia For Cardiovascular Surgery

Front 1

key concept regarding cardiopulmonary bypass

Back 1

-cardiopulmonary bypass (CPB) diverts venous blood away from the heart, adds oxygen, removes CO2, and returns the blood to a large artery (usually the aorta). As a result nearly all blood flow through the heart and lungs stops

Front 2

key concept regarding the fluid level in the CPB reservoir

Back 2

-the fluid level in the reservoir of the CPB machine is critical: if the reservoir is allowed to empty, air can enter the main pump and cause a fatal air embolism

Front 3

key concept regarding the initiation of CPB

Back 3

-the initiation of CPB is associated with a marked increase in stress hormones and a variable systemic inflammatory response

Front 4

key concept regarding determining the adequacy of cardiac reserve in patients

Back 4

the adequacy of cardiac reserve should be based on:

-exercise tolerance
-measurements of myocardial contractility such as EF
-the severity and location of coronary stenosis
-ventricular wall motion abnormalities
-cardiac end-diastolic pressures
-cardiac output
-valvular area and gradients

Front 5

key concept regarding redo sternotomy

Back 5

-blood should be available for immediate transfusion in redo sternotomies, since the right ventricle or coronary grafts may be adherent to the sternum and can be accidentally entered during the repeat sternotomy

Front 6

key concept regarding pulmonary artery catheterization

Back 6

it should be used in patients with:

-compromised EF (<40-50%)
-pulmonary hypertension
-in complicated procedures

Front 7

key concept regarding TEE

Back 7

-provides valuable information about cardiac function and anatomy

2D, multiplane TEE can detect:
-regional and global ventricular abnormalities
-chamber dimensions
-valvular anatomy
-presence of intracardiac air