pr20
Forum Senior
Topics: 24
Posts: 180
|
A 64 year old Caucasian male is scheduled for abdominal aortic aneurysm repair.The aneurysm was diagnosed one year ago and seems to be progressively increasing in size.He denies chest pain,palpitations,cough or ankle swelling.His past medical history is significant for diabetes mellitus diagnosed 5 years ago and mild hypertension.He is an ex-smoker with 15 pack-year history.His blood pressure is 134/55 mmhg and his heart rate is 78,regular.Physical examination reveals a right sided carotid bruit but otherwise insignificant.His hemoglobin level 10.5 mg/dl,his MCV is 70fl,his platelet count is 1,90,000/mm3 and his creatinine level is 1.2 mg/dl.The patient would most likely benefit from which of the following perioperative treatments?
1.Beta blocker
2.Calcium channel blocker
3.ACE inhibitor
4.Iron supplementation
5.Blood transfusion
|
| kpmle2
Forum Guru
Topics: 95
Posts: 512
|
1.Beta blocker
|
| Eagle_303
Forum Guru
Topics: 77
Posts: 655
|
Blood transfusion.
The person is anemic and scheduled for AAA repair.He is likely to lose more blood .One of major postoperative complication of AAA repair is Cardiac ischemia.Patient should not be anemic for this repair .Just a thought
|
| pr20
Forum Senior
Topics: 24
Posts: 180
|
Answer is A.Beta blocker
Beta blocjers have been shown to improve outcomes such as death and MI in high risk patients undergoing major non-cardiac surgery(such as aortic aneurysm repair).
Blood transfusion is typically done with Hb of 7-8 mg/dl in healthy individuals and 10 mg/dl in patients with underlying cardiac disease(CHF).
|
| Eagle_303
Forum Guru
Topics: 77
Posts: 655
|
very nice ;
So in the presence of so much anemia a patient can be subjected to Vascular surgery .Looks strange.
What is the source of this information ???
|
| Eagle_303
Forum Guru
Topics: 77
Posts: 655
|
Preoperative details
Preoperatively, obtain a careful history and perform a physical examination and laboratory assessment. From the information derived from these basic assessments, perioperative risk and life expectancy after the proposed procedure can be estimated.
Carefully consider whether the patient's current quality of life is sufficient to justify the operative intervention. Because the disease process affects elderly persons who may be debilitated or may have mental deterioration, this decision is made in conjunction with the patient and family.
Once the decision is made, identify comorbidities and risk factors that increase the operative risk or decrease survival. Ascertain the patient's activity level, stamina, and stability of health. Perform a thorough cardiac assessment tailored in accordance with the patient's history, symptomatology, and results from preliminary screening tests such as the electrocardiogram and stress test.
Because COPD is an independent predictor of operative mortality, assess lung function by performing a room-air arterial blood gas measurement and pulmonary function tests. In patients with abnormal test results, preoperative intervention in the form of bronchodilators and pulmonary toilet often can reduce operative risks and postoperative complications.
Preoperative intravenous antibiotics (usually a cephalosporin) are administered to reduce the risk of infection. Arranging for appropriate intravenous accesses to accommodate blood loss, arterial pressure monitoring through an arterial line, and Foley catheter placement to monitor urine output are routine preparations for surgery. For patients at high risk because of cardiac compromise, a Swan-Ganz catheter is placed to assist with cardiac monitoring and volume assessment. Transesophageal echocardiography can be useful to monitor ventricular volume and cardiac wall motion and to provide a guide with respect to fluid replacement and pressor use.
Prepare for blood replacement. The patient should have blood available for transfusion. Intraoperative Cell Saver use and preoperative autologous blood donation have become popular.
Maintain a normal body temperature during the operative intervention to prevent coagulopathy and maintain normal metabolic function. To prevent hypothermia, place a recirculating, warm forced-air blanket on the patient and warm any intravenous fluids and blood before administration.
The following are standard preoperatively:
- Type and crossmatch blood.
- Administer prophylactic antibiotics (cefazolin, 1 g intravenous piggyback).
- Insert a Foley catheter.
- Establish large-bore intravenous access.
- Monitor central venous pressure or establish Swan-Ganz catheterization (if indicated).
- Prepare the skin from the nipples to the mid thigh.
- Administer general anesthesia (with or without epidural anesthesia).
- Cell Saver use has become popular.
- Insert a nasogastric tube.
Source http://www.emedicine.com/med/TOPIC3443.HTM
These guidelines are for those patients who are NOT ANEMIC. Don't you think a patient who is undergoing a major vascular surgery must be correct by blood transfusion.
|
| pr20
Forum Senior
Topics: 24
Posts: 180
|
This is a UW question.
You have a good point but some patients tolerate low levels of Hb very well and this patient doesn't have any symptoms of anemia.Morever patient has many risk factors for MI like smoking,hypertension,diabetes mellitus....so it is more important to prevent MI in this high risk patient undergoing surgery.
As a guideline,I think we need to follow the UW point--->Blood transfusion is typically done with Hb of 7-8 mg/dl in healthy individuals and 10 mg/dl in patients with underlying cardiac disease(CHF).
|
| Eagle_303
Forum Guru
Topics: 77
Posts: 655
|
UW is has very good source of questions but not an authority.Don't you think that if O2 is not going to the heart ,then How beta blockers can help the patient
|
|
| |
| | | | | | | | |
Similar forum topics