Post Op Delirium
Theories: Mangement:
LVAD — Non-cardiac Surgery
Non-Cardiac Surgery in Patients with LVADs Left ventricular assist devices (LVADs), particularly the HeartMate 3, are increasingly encountered in non-cardiac surgical settings. These patients require a solid understanding of device physiology and thoughtful intraoperative management. Quick Reference: Intraoperative LVAD Management Monitoring Perioperative Support Key LVAD Responses Suction (“Suck-Down”) Event Management: LVAD Physiology: Core Concepts LVADs
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Aortic stenosis
Aortic Stenosis (AS): aortic valve narrows, restricting blood flow from the heart’s left ventricle. Presents with “SAD” symptoms. Syncope, Angina, Dyspnea. Causes: Key Concept: Pressure overload → concentric LV hypertrophy Decreased LV compliance → diastolic dysfunction Dependence on atrial kick for ventricular filling Increased myocardial oxygen demand + reduced supply Remember the Law of LaPlace:
Cardiac Set up
🫀 OR Setup Initial Equipment Grab Setup: AAA “Shopping List” Notes: 🧰 Room Setup Standard Checks Monitors (usually dont need NIBP) 🫁 Airway Setup 💉 IV / Lines 💊 Drug Setup General Workflow Standard Infusions 💉 Cardiac Drug Syringes Syringes: Core Drugs Extras 🩸 Line Setup A-line Tips: Triple Transducer Color setup: Swan-Ganz Hotline 🔄
Dilutions
Among the craziness of residency is the learning of medications. Below is a list of standard dilutions used. This should not be a substitute to understanding the process of dilution Pressors Phenylephrine Ephedrine Norepinephrine Optional dilution: Epinephrine Infusion example: Vasopressin Hypnotics Dexmedetomidine (Precedex) Opioids Sufentanil Remifentanil Common preparations: Notes: Antihypertensives Nicardipine