The incidence of perioperative death with ES is ___, and the rate of maternal mortality is ____.
What occurs with increased FiO2 and what should be considered with ES pt's?
pulm vasodilation with increased O2 will decrease shunt fraction in normal patients. O2 causes VASODILATION!
Why is NO pathway used for ES? what drugs are used in this category?
increased cGmp causes smooth muscle relaxation
prostacyclin analogue, direct dilator but must have continuous infusion
endothelin receptor antagonist.
Can decrease PVR by 25%.
oral takes months to work and decreases effectiveness of oral contraceptives.
_________ are used with O2 therapy to cause _______ __________.
____ ________ are contraindicated in ES pt's.
What complications are seen with ES?
bleeding disorders- ^ PT PTT
Hypertrophic Osteoarthropathy- seen in ankles.
What decreases are seen in the pulmonary system?
peak exp flow rate
What increases are seen in the pulmonary system?
closing lung volume
increasd ___ pressure should be avoided with ES. what other things will increase PVR and shunt fraction?
increased pulm blood flow
what things should be avoided with ES?
extreme HR changes
decreased venous return
keep the shunt ________. Causes of increased R L shunt are:
avoid ____ _______. ___ drugs will work ____ and inhalational drugs will work _____. Be careful with fluid titration bc lowered tolerance for pre-load and afterload. RBC threshold is _______. Avoid Pain.
should you use a Pulm artery catheter in ES?
risks outweigh benefits.
Bosentan and EPoprostenol can prolong what drugs?
What two things should be kept low with ES?
AHA antiboitic IE prophylaxis for CHD with low O2 levels, not fully repaired and surgical shunt or conduit.
also with any residual effects if repaired or recently repaired
Spinal may cause ________, and should not be done.
max insufflation pressure for laparoscopic surgery _____. should do open when possible.
ES will show high ___ > ___%
How can shunt be monitored in a pt with ES due to PDA?
L foot will have a lower sat bc descending aorta is post-ductal