ABA Cardiac Anesth flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Coronary perfusion pressure

Difference between aortic diastolic pressure and left ventricular end-diastolic pressure; it drives coronary blood flow, which occurs mainly in diastole and falls when LVEDP rises.

ESPVR slope

Slope of the end-systolic pressure-volume relationship, also called Ees; it is a load-independent index of contractility that steepens with inotropic stimulation and flattens in heart failure.

Milrinone

Phosphodiesterase-3 inhibitor that raises intracellular cyclic AMP, producing inotropy and vasodilation; half-life is 2-4 hours, it is renally cleared, and it can cause hypotension and thrombocytopenia.

Etomidate adrenal suppression

Even a single induction dose inhibits 11-beta-hydroxylase and can lower cortisol for 24-48 hours; its hemodynamic stability makes it useful in shock, though use in sepsis is debated.

Frank-Starling relationship

Rising preload increases stroke volume up to an optimal sarcomere length; the failing ventricle has a flatter curve, so afterload reduction and inotropes matter more than volume loading alone.

STS risk score

Multivariable model predicting operative mortality and major morbidity for cardiac surgery; variables include age, renal function, ejection fraction, reoperation, urgency, and procedure type.

Perioperative beta-blocker rule

Continue chronic beta-blockers through surgery, but do not start them on the day of surgery, because acute loading increases hypotension, bradycardia, and stroke risk.

P2Y12 inhibitor stop times

Before cardiac surgery, stop clopidogrel 5 days, ticagrelor 3-5 days, and prasugrel 7 days; aspirin is usually continued to reduce ischemic events and graft thrombosis.

Four METs

Functional capacity of at least 4 METs, such as climbing a flight of stairs, predicts low perioperative cardiac risk and often permits surgery without further stress testing.

Warfarin bridging

Stop warfarin about 5 days before surgery; bridge with low-molecular-weight heparin only for high thrombotic risk, such as a mechanical mitral valve, recent stroke, or prior embolus.

Pulse pressure variation

PPV greater than 13% in a ventilated patient with sinus rhythm predicts fluid responsiveness; it is unreliable with arrhythmias, spontaneous breathing, low tidal volumes, or an open chest.

TEE contraindications

Absolute contraindications include esophageal stricture or tumor, perforated viscus, active upper gastrointestinal bleeding, and recent esophageal or gastric surgery; large hiatal hernia is a relative contraindication.

Midesophageal four-chamber view

TEE view at approximately 0-20 degrees showing all four chambers and both atrioventricular valves; used to assess biventricular function, chamber size, and valve pathology.

Pulsus paradoxus

Inspiratory fall in systolic pressure greater than 10 mmHg; it reflects exaggerated ventricular interdependence and is seen in cardiac tamponade, severe asthma, and constrictive pericarditis.

Mixed venous oxygen saturation

SvO2 reflects the balance between oxygen delivery and consumption; normal is about 70-75%, and a fall suggests low cardiac output, anemia, hypoxemia, or increased metabolic demand.

Heparin dosing for CPB

Give 300-400 units/kg to achieve an activated clotting time above 400-480 seconds; recheck the ACT every 30 minutes and before separating from bypass.

Protamine reversal

Give 1 mg protamine per 100 units of total heparin, slowly, because rapid administration causes histamine release, hypotension, pulmonary vasoconstriction, and rare anaphylaxis.

Del Nido cardioplegia

Single-dose crystalloid cardioplegia containing blood, lidocaine, magnesium, and mannitol; it provides up to 90 minutes of arrest and is common in pediatric and complex adult cases.

IABP contraindications

Aortic regurgitation, aortic dissection, severe peripheral arterial disease, and sepsis; the balloon inflates in diastole to augment coronary flow and deflates in systole to reduce afterload.

Continuous-flow LVAD

Pump that unloads the left ventricle into the aorta; many patients lack a palpable pulse, so mean arterial pressure and pump parameters guide care; right heart failure is a major risk.

Chest tube bleeding threshold

Output greater than 200 mL per hour for 2 consecutive hours, or more than 400 mL in the first hour, suggests surgical bleeding and warrants coagulation testing and consideration of reexploration.

Vasoplegic syndrome

Post-bypass hypotension with low systemic vascular resistance and normal or high cardiac output; treat with norepinephrine, vasopressin, and methylene blue after excluding bleeding and pump failure.

Postoperative atrial fibrillation

Occurs in 20-40% of patients after cardiac surgery; beta-blockers reduce incidence, amiodarone is used for rhythm control, and electrolytes and precipitating causes should be corrected.

Low cardiac output syndrome

Cardiac index below 2.0-2.2 L/min/m2 with hypotension, oliguria, cool extremities, and rising lactate; treat with inotropes, vasodilators, mechanical support, and correction of ischemia or tamponade.

Fontan circulation

Passive flow from the systemic veins to the lungs; cardiac output depends on low pulmonary vascular resistance, so hypoxia, hypercapnia, high airway pressures, and hypovolemia are poorly tolerated.

Denervated transplanted heart

The donor heart lacks vagal and sympathetic innervation; atropine is ineffective, and isoproterenol or direct-acting agents are used to increase heart rate and support output.

Eisenmenger syndrome

Long-standing left-to-right shunt causing pulmonary vascular disease and shunt reversal; systemic vasodilation, hypoxia, and acidosis worsen right-to-left shunting and cyanosis.

Carcinoid crisis

Sudden release of vasoactive peptides causes severe hypotension, bronchospasm, and arrhythmias; octreotide is the treatment and is often given prophylactically before tumor manipulation.

WHO surgical safety checklist

Three-phase checklist of sign in, time out, and sign out that improves team communication and reduces complications; cardiac versions add items for TEE, bypass, and anticoagulation.

Morbidity and mortality conference

Structured, confidential peer review of complications and deaths; it supports system improvement and individual learning, and just-culture principles separate human error from reckless behavior.

Central line bundle

Hand hygiene, maximal sterile barrier, chlorhexidine antisepsis, optimal site selection, and daily review of line necessity; together these reduce catheter-related bloodstream infections.

Surgical antibiotic prophylaxis timing

Give prophylaxis within 60 minutes before incision, or 120 minutes for vancomycin and fluoroquinolones; redose during long cases and maintain normothermia and normoglycemia.