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Induction of Anesthesia for Cardiac Surgery - Burke 2014
Terms in this set (27)
Anesthetic management goals for CABG
-Avoid increases in myocardial O2 consumption
-Avoid tachycardia (it compromises O2 delivery @ any MAP)
Premedication for Cardiac Surgery: Poorly Compensated patients...
Lorazepam or midazolam 1-2mg IV
Premedication for Cardiac Surgery: Compensated patients...
1- Midazolam 1-5mg IV titrated to effect with or without IV morphine 2-5mg, Hydromorphone 1-2mg or Fentanyl 50-100mcg IV after arrival in the pre-induction area or OR.
2-Morphine with/without scopolamine IM
Setup: IV drugs prepared
To be most prepared at least:
-one vasodilator (NTG)
should be set up and connected to a pump that is preprogrammed & ready to use.
Setup: Syringes prepared
Also, syringes should be prepared for bolus doses of at least:
Drugs to have prepared pre-op:
-Inotrope (Epi, Dopamine, Dobutamine drip or Epi syringe)
-Ephedrine (mix vasopressor/inotrope)
-Phenylephrine (50-100mcg bolus or as infusion) OR norepinephrine
-Heparin (do not draw up protamine until off CPB)
Checks prior to induction:
-Reassessment of patients overall cardiopulmonary & airway status
-Integrity of breathing circuit and immediate availability of suction
-Availability of blood for transfusion
-Proximity of a surgeon or a senior resident/fellow
-Any special ETT needs (double lumen/bronchial blocker)
-Immediate availability of emergency cardiac drugs
Fast track technique: Pre-medication:
1-2mg Versed IV in the holding room
Fast track technique: Induction
Fentanyl 15-20 mcg/kg
...in combo with a muscle relaxant (vec/roc/cis)
Fast track technique: Maintenance
Fast track technique: During CPB
Isoflurane via CPB machine
Fast track technique: Post CPB
Isoflurane is maintained & NO additional narcotics administered.
Either propofol 20-50mcg/kg/min OR Dexmedetomidine (precedex) 0.1-0.7mg/kg/min prior to transport
Physiologic Issues: Hypovolemia
Anesthetic drugs may impair appropriate hemodynamic responses.
-Propofol & Thiopental = venodilation/ decreased SVR/peripheral pooling of blood/decreasing sympathetic tone/depress myocardial contractility
Circulatory depression by Anesthetic agents most to least:
Propofol > Thiopental > Midazolam > Etomidate
All anesthetics except ________ decrease BP by some combination of: Removing Sympathetic tone, directly decreasing SVR, Directly depressing the myocardium, increasing venous pooling (reducing venous return) OR inducing bradycardia
WHat is the safest way to induce critically ill patients?
reducing the doses of anesthetic drugs
What is the muscle relaxant of choice for patients with baseline HR < 50BPM or with valvular regurgitation?
(remember with regurg want FAST, FULL, FORWARD)
High dose opoid techniques
Stress response suppression and hemodynamic stability
Lost favor in the 1990's because of long post-op intubation times, but still useful for high risk patients who will require overnight mechanical ventilation regardless of anesthetic technique chosen
Anticipated difficult intubation:
Concerns about airway control supersede those about hemodynamic stimulation, yet both airway safety and hemodynamic stability can be achieved in an awake intubation
Which 2 inhalational agents are more likely to reach concentrations consistent with stress response suppression (generally 1.3-1.5x MAC) during a customary induction period?
Desflurane & Sevoflurane
(compared to Iso)
Which inhalation agents can be used during induction as a complement to an IV induction?
Inhalation induction slide
IV induction amount of fentanyl
IV induction amount of propofol
IV induction amount of Succs
IV induction gas used
Iso @ 0.5-1 MAC
Inhalation induction gas
Sevo @ 2%
THIS SET IS OFTEN IN FOLDERS WITH...
SAB, Epidural Anesthesia
Full List Anesthesia Acronyms
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