Term
| What are s/s of Peripheral Vascular Disease? |
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Definition
| Intermittant claudication, gangrene, pain in calves, thighs or hips, usually stops with rest, bluish discoloration of extremity |
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Term
| Name typical procedures performed on the patient with PVD/PAD. |
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Definition
Femoral to Femoral Bypass
Femoral to Popliteal bypass/Dorsalis Pedis
Axillary to femoral Bypass
Thoombectomy
Angioplasty/Stent placement
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Term
| List some associated medical concerns for the patient with PVD |
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Definition
>50yrs old
Smoker/COPD
DM
Sedentary lifestyle
Obesity
HTN
Men>Women
5% of people >50 years old
Renal disease |
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Term
| What is the major source of intraop morbidity and mortality with PVD patients? |
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Definition
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Term
| What should be assessed in preop in the patient with PVD? |
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Definition
Thorough H&P
Typical labs, BUN & Creat, possibly coags
T&S
CXR/PFTs
EKG
Blood Sugar
Cerebral Studies
Cardiac Evaluation
Stress Test
Cardiac Clearance
2D Echo
Check Medication list |
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Term
| List some intraop considerations for the patient with PVD |
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Definition
*PIV usually OK
*+/- Arterial line
*Regional, GETA, and MAC all acceptable
*5 lead EKG
*Heparin ready in room
*May utilize protamine
*Surgery can be very lengthy
*Utilize warmers, foley, and positioning
*Blood loss
*Intra-op Angiongram (if dye used RI may be present, keep hydrated, but not overloaded)
*Surgery may be emergent for limb salvage (pt may be a full stomach, anticoagulated, patient will not be tuned up)
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Term
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Definition
*Monitor pulses and color of extremity
*Pain relief- PCA, Intrathecal narcotic, Epidural,IV narcotics
*Watch closely for complications |
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Term
| List some AV graft procedures |
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Definition
*Thrombectomy
*Insertion or creation of graft
*Removal of infected graft
*Revision of graft or shuntogram |
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Term
| What two things about an ESRD patient must the anesthetist know prior to surgery? |
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Definition
| What the K+ is and when the last HD was |
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Term
| What type and how much fluid should be utilized in an AV graft procedure and why? |
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Definition
| 0.45% NS at KVO to prevent further electrolyte distrubances |
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Term
| Where should the blood pressure be kept during surgery for the PVD patient? |
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Definition
| PVD patients are almost always hypertensive, and their BP must be kept with in 20% or baseline in order to keep graft open. The autoregulation curve will shift to the right low pressure will lead to venous stasis and reclotting of graft. |
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Term
| What are some important considerations for the patient getting a Fem-Pop? |
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Definition
*All same principles for vascular surgery apply
*Absolutely need cardiac work up
*Art line is common
*Decrease drug dosages
*SAB is a nice technique if patient can tolerate
*GETA used with a slow and smooth induction
*Utilize warming devices
*Expect to give Heparin and sometimes a small dose of protamine sulfate
*ICU or step down for post op |
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Term
| Considerations for those undergoing Varicose Vein Ligation |
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Definition
*Usually younger healthier population
*Mark the legs while standing, don't over sedate pre-op!
*Give pre-op meds after site is marked
*Usually outpatient procedure
*SAB or LMA general
*minimal blood loss |
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