AP III- Exam I- Eisenmenger's

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Anonymous
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222622
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AP III- Exam I- Eisenmenger's
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2013-06-05 21:02:13
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aa emory ap
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Eisenmenger's syndrome - anesthesia care
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  1. T or F: A sat of 90% or below is normal for ES?
    T
  2. Define ES:
    Pulmonary HTN with reversed or bidirectional shunt.

    R-> L
  3. What are possible shunt locations?
    • AORTA:
    • Patent Ductus arteriosus
    • aortico-pulmonary septal defect
    • ATRIAL:
    • ASD
    • Total anomolous pulmonary return
    • VENTR:
    • VSD
    • Tricuspid atresia
    • pulmonary stenosis
    • single ventricle
  4. ES starts with a L to R shunt.  describe what this does to the pulmonary system.
    • increased blood flow --> vessel damage (become  more muscular) --> Pulm HTN
    • R to L shunt
    • R sided cardiomegaly and heart failure
  5. When sx of ES occur it is ____ ____ for surgery.
    too late
  6. What percent of CHD pt's develop ES?
    8-11%
  7. The incidence of perioperative death with ES is ___, and the rate of maternal mortality is ____.
    • 19%
    • 45-60%
  8. 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!
  9. Why is NO pathway used for ES? what drugs are used in this category?
    • increased cGmp causes smooth muscle relaxation
    • Viagra/cialis
  10. Describe Epoprostenol.
    prostacyclin analogue, direct dilator but must have continuous infusion
  11. Describe Bosentan:
    • endothelin receptor antagonist. 
    • Can decrease PVR by 25%.
    • oral takes months to work and decreases effectiveness of oral contraceptives.
  12. _________ are used with O2 therapy to cause _______ __________.
    • bronchodilators
    • pulmonary vasodilation
  13. ____ ________ are contraindicated in ES pt's.
    Pace Makers
  14. What complications are seen with ES?
    • bleeding disorders- ^ PT PTT
    • renal dysfunction-
    • Hemoptysis
    • Cholelithiasis
    • Hypertrophic Osteoarthropathy- seen in ankles.
    • Gout
    • CVA
  15. What decreases are seen in the pulmonary system?
    • lung capacity
    • vital capacity
    • FEV
    • peak exp flow rate
    • Compliance
  16. What increases are seen in the pulmonary system?
    • residual volume
    • closing lung volume
  17. increasd ___ pressure should be avoided with ES. what other things will increase PVR and shunt fraction?
    • LA
    • hypercarbia
    • hypoxia
    • acidosis
    • increased pulm blood flow
  18. what things should be avoided with ES?
    • myocardial depression
    • extreme HR changes
    • decreased venous return
    • volume overload
  19. keep the shunt ________.  Causes of increased R L shunt are:
    • balanced
    • decreased SVR
    • increased PVR
  20. 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.
    • air embolism
    • IV
    • fast
    • slow
    • increased
  21. should you use a Pulm artery catheter in ES?
    risks outweigh benefits.
  22. Bosentan and EPoprostenol can prolong what drugs?
    NDMR
  23. What two things should be kept low with ES?
    Co2, pip
  24. 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
  25. Spinal may cause ________, and should not be done.
    sympathectomy
  26. max insufflation pressure for laparoscopic surgery _____. should do open when possible.
    14 mmhg
  27. ES will show high ___ > ___%
    • Hct
    • 60
  28. 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

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