| A | B |
|---|
| CABG uses either | saphenous vein or int. mammary artery |
| 4 candidates for CABG | pts. with intractable angina pectoris, high risk pathophysiology. unstable angina, AMI |
| high risk pathology for CABG | left main stem coronary artery disease or triple vessel disease |
| better candidate for PTCA | blockage in larger coronary artery |
| better candidate for CABG | blockage too low for PTCA, too numerous & must have viable tissue |
| ej fractions good risk for CABG | >55% |
| ej fraction poor risk for CABG | <30% |
| CABG pre op avoid ASA for | 7 days |
| CABG pre op avoid anticoagulants for | 5-6 days |
| When ASA can be given post op CABG | 7 hrs. |
| Persantine can be given ____days pre op | 2 days |
| Continue these for 1 yr. post op | ASA & Persantine |
| Stop smoking | 2 weeks before surgery |
| Antiarrhythmics continued until | night before surgery |
| how often to do incentive spirometry | q hr. while awake |
| how often to do neb treatments | q 4 hrs. |
| pain meds post CABG | q hr prn |
| how long patients stay on vent after CABG | 12 hrs. |
| minimally invasive CABG advantages | no bypass machine, shorter, extubate in OR |
| indication for MIDCABG | revascularization of the ant. coronary arteries |
| conduit for MIDCABG | IMA 1 |
| anticoagulation during extracorporeal circulation | heparin |
| blood flow in ECC | from IVC & SVC to machine, then back to ascending aortic arch |
| pt. temp in aorto coronary bypass | 25 degrees to 80 degrees C |
| heart filled with this during aorto coronary bypass | lactated Ringers (RL) |
| this is used to arrest the heart | Physiosol |
| temp of RL during CABG | 15 degrees centigrade |
| 3 common graft conduits | saphenous, IMA or radial artery |
| saphenous vein reversed in CABG | due to valves |
| IMA advantages | greater chance of remaining patent; good for only one blockage |
| IMA disadvantages | takes longer to dissect; vessel is shorter |
| Radial artery advantages | greater long & short term patency |
| need to make sure this is ok before using radial artery | patent ulnar artery |
| these are placed after CABG | atrial & ventricular epicardial pacing wirse, mediastinal chest tubes & possibly pleural chest tube |
| reason for needing a pleural chest tube after CABG | IMA 2 |
| used to reverse heparin | protamine sulfate |
| auto transfusion if hgb less than | 8 |
| auto transfusion must be done with blood within | 6 hrs. |
| used to improve myocardial perfusion | IABP (intr aortal balloon pump) |
| IABP works by | decreasing afterload & improving cardiac output |
| right atrial pressure with cvp | 2-6 mm Hg |
| pulmonary artery pressure | mean of 15 mm Hg |
| Pulm capillary wedge presure | 4-12 mm Hg |
| With CABG PCWP excpected to be | 8-16 mm Hg |
| cardiac output | 4-8 L |
| stroke volume | 70 ml per beat |
| CI = CO divided by | BSA |
| CI less than this is incompatible with life | <1.2 L/min/m2 |
| GOal in OHRR is CI | >2 L/min/m2 |
| Acceptable CI | 2.5 - 4 L/min/m2 |
| gives information about afterload | SVR |
| SVR increased with | vasoconstriction and HTN |
| NL SVR | 900-1200 |
| SVRI | 19-24; less than 25 |
| SVRI are like | young adults (19-24) |
| preload things | CVP, PAP, PCWP |
| contractility | CI |
| afterload things | SVR, SVRI |
| SVO2 goal #'s | 60-80% |
| best indicator of how well tissues are being perfused | SV02 |
