Question Answer Preoperative optimization of______ must be aggressively managed to decrease _______ cardiac function, perioperative or late morbidity and mortality secondary to cardiac causes The purpose of the preoperative anesthesia evaluation is to delineate the extent of ______ any underlying comorbid pathology and medically optimize the patient for surgery. The strong association between _______ mandates a thorough assessment of any underlying pulmonary disease. smoking and vascular disease ______(medication class)Advantageous for their effect on oxygen supply and demand B-blockers Ideally, start the ?-blocker _______. Target heart rate between ______ days to weeks prior to surgery, 50 to 60 bpm. Should also be continued througout the postoperative period Macrophages transform into _____. These + _______ form the core of plaque foam cells, extracellular lipid ***The extent of disability is in part determined by collateral blood flow Mortality in patients with PVD: _____ fold higher than the general population. two to six PVD pharm treatment antiplatelet agents, ?-blockers, angiotensin-converting enzyme inhibitors, statins, and strict glucose control account for more than half of the mortalities associated with PVD Cardiac events Preoperative ______ must be aggressively managed to decrease perioperative or late morbidity and mortality optimization of cardiac function Why is B-blockade not recommended to be started the day of sx. helps reduce MI's but increases the risk of hypotension, bradycardia, stroke, death Beneficial for their cardioprotective effects, ability to reduce vascular inflammation, decrease thrombogenesis, stabilize atherosclerotic plaques, and lower the concentration of lipids statins Statin therapy should be initiated when? 30 days prior to sx and continued postoperatively The use of _____ is important for long-term management of ASCVD, antiplatelet agents – but risks and bennies must be carefully weighed in noncardiac, noncarotid vascular surgery. a general concept to consider in PVD is: The greater the number of comorbidities, the greater the risk of perioperative morbidity and mortality. Anesthetic goal Maintain Consistent Hemodynamic Control: Avoid swings in blood pressure! When should you use regional anesthesia? When for GETA? As often as possible – but as much as possible on LOWER EXTREMETIES. Use GETA on invasive procedures Three things to consider intraoperatively Anemia & hypothermia increases chances of MI, control hyperglycemia (80-110) – hold Metformin Why would you hold metformin? lactic acid release Really simply – what is it your trying to limit with PVD Increased SNS or anything that would put extra strain/stress on the heart
Pathophysiology Test 2: PVD

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