ANOTHER QUIZ FOR YOU

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PULMONARY ARTERY PRESSURE MONITORING

PULMONARY ARTERY PRESSURE MONITORING

Pulmonary artery pressure monitoring is measuring the pressure in the pulmonary artery leading to the lungs. It also allows for indirect measurement of left heart pressures since the pulmonary veins have no valves in them and collects the information needed to calculate cardiac output and resistance. The PA catheter assesses all 3 components of stroke volume: preload, afterload, and contractility.

The catheter is 60-100 cm long and the caliber is 4-8 Fr (a standard suction catheter is 14 French)...the balloon will hold 0.5-1.5 ml of air and get 8-13 mm big when inflated
Distal Port:
• terminates in the pulmonary artery
• used to monitor pulmonary artery pressure and pulmonary capillary wedge pressure when the balloon is inflated
• provides a port for mixed venous blood samples
Balloon Inflation Port:
• used to inflate the balloon at the end of the PA catheter with no more than 1.5 ml of air
• has a locking device for safety
• is inflated during insertion to allow the catheter to float into correct position
• when inflated will measure pulmonary capillary wedge pressure, which is equal to the pressure in the left atrium and ventricle during diastole

Proximal Injectate Port:
• is usually blue in color
• provides a port for injecting fluid when measuring CO
• measures RA/CVP
• can be used as an IV infusion site if CVP monitoring not needed
Proximal Infusion Port:
• is usually white in color and AKA venous infusion port
• lumen opens into the RA
• can be used to infuse fluids or meds without interruption
• is not attached to the transducer

Cardiac Output Port:
• a white square port with pins that connects to the CO cable
• the CO cable connects to the monitor
• has temperature sensitive wires that terminate near the distal tip

• is used for thermodilution CO measurement

Other Ports:
• Pace Port for a ventricular or atrial pacemaker
• SvO2 monitoring port

SO, YOU THINK YOU CAN ADMINISTER ANESTHESIA!

TAKE THE QUIZ AND PROVE IT.

The Indian Anaesthetists' Forum Quiz on Anaesthesia Equipment

THE ROLE OF 10, Mitral reguregitation

What is the role of 10?

These are 10 points you can remember about a particular subjects.Tthese 10 points if you speak about during your viva session your examiner will be thrilled.
If you expand each point during written exam you can cover the subject effeciently.
If you apply them clinically you patient is saved.

 

1. Acute MRis ususlly due to myocardia ischemia, infective endocarditis, or chest trauma.
2. Chronic MR is due to rheumatic fever, congenital abnormality in valve apparatus.
3. The principal derangement is reduction inforward stroke volume causing symptoms of low cardiac output.
4. Chronic MR usually presents as low COP symptoms because left atrium has time to dilate and accomodate the reguritanat blood.
5. Acute MR presents as pulmonary congestion or hypertension, because aleft atrium dose not have time to dilate to accomodate the reguritant blood.
6. Anesthetic goals: avoid bradycardia, increase in afterload( both will increase the regurgitant volume), hear rate should ideally kept between 80-100/m.
7. Premedication may decrease stress elevation of afterload but shoyld be used cautiously as co2 elevation may increase pulmonary pressure in patient with pulmonary hypertension.
8. Spinal and epidural cen be tolerated in patients with preserved ventricular function.
9. Opioid based technique is preferrable to inhalational agents in patients with moderate to severe ventricular impairment.
10. Pancuronium can be useful slection of muscle relaxant agents in combination with opioids.

Aortic stenosis, role of 10

What is the role of 10?

These are 10 points you can remember about a particular subjects.Tthese 10 points if you speak about during your viva session your examiner will be thrilled.
If you expand each point during written exam you can cover the subject effeciently.
If you apply them clinically you patient is saved.

Aortic stenosis(AS)

1. It is nearly always congenital, rheumatic or degenerative 
2. AS---LV hypertrophy, reduced LV compliance, diastolic dysfunction.LV filling is quiet dependant on normal atrial contraction. 
3. Graded into:              Mild                    Moderate                                severe

    Aortic valve area            1.2-2cm             2 0.8-1                                        ˂ 0.8

Aortic-LV pressure gradient 16-34mmHg                    35-75                                           ˃ 75


4.   Anesthetic goals:

• maintain sinus rhythm 
• Maintain heart rate 60-90/m
• Maintain intravascular volume.

5. Premedication is useful in preventing unnecessary increase in heart rate and afterload.
6. Spinal and epidural are contraindicated in patients with severe AS.
7. Induction: primarily opioid based or combination of ketamine and benzodiazepine.
8. Maintenance is with opioid based technique.
9. Vecuronium, rocuronium can be used as muscle relaxant. Pancuronium is best avoided.
10. Phenylephrine is preferred as vasopressor over ephedrine because it lacks B agonist activity.

Mitral stenosis, role of 10

What is the role of 10?

These are 10 points you can remember about a particular subjects.
These 10 points if you speak about during your viva session your examiner will be thrilled.
If you expand each point during written exam you can cover the subject effeciently.
If you apply them clinically you patient is saved.

Mitral stenosis(MS)

1. MS is almost always caused by rheumatic fever, commonly in conjunction with other valvular lesions

2. MS---left atrial volume and pressure overload----LA dilataion----increased PVR---pulmonary hypertension----right ventricular hypertrophy and failure.

LA dilatation--- promotes AF and embolic events.

3. Graded into

                                                   Mild                     Moderate                           severe

MITRAL VALVE AREA         2-1.5 cm                   2 1.6-1                                ˂1

Lv-LA pressure gradient           2-6 mmHg                 6-12                                    ˃ 12

Pressure half time                       100ms                       200                                      300

4. Anesthetic goals

•  maintain sinus rhytm 
• Avoid tachycardia 
• Avoid hypovolemia, hypervolemia

5. Patients are very sensitive to the vasodilating effect of spinal and epidural technique

6. Induction is with standard IV agents with possible exception of ketamine

7. Maintainance is with opioid based technique

8. N2O may increase PVR and cause pulmonary hypertension

9. Vecuronium, rocuronium can be used as muscle relaxant. Pancuronium is best avoided.

10. Phenylephrine is preferred as vasopressor over ephedrine because it lacks B agonist aactivity.

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"I love you too," I said, with a dopey grin plastered on my face. I was about to hang up when I heard him ask sweetly, "Mommy, who was that?"