Case Western Reserve University
MetroHealth Medical Center Department of Anesthesiology
Anesthesiology Resident Cardiothoracic Anesthesia Rotation

Questions for CA-1 Rotation in Cardiac Anesthesia

Charles E. Smith, MD, FRCPC
Director, Cardiothoracic Anesthesia, MHMC

All residents are expected to complete these questions during their CA-1 rotation in cardiac. Residents are also expected to have read the corresponding Chapters in the current edition of Miller�s Textbook of Anesthesia.

1. List 3 symptoms of poor ventricular function (history).
2. List 3 signs of poor ventricular function (physical).
3. What information can be derived from exercise electrocardiography?
4. What information can be derived from echocardiography?
5. What information can be derived from cardiac catheterization?
6. List 5 conditions that are detrimental to myocardial oxygen balance in patients with coronary artery disease.
7. a. What are the branches of the right and left coronary arteries?
   b. What is the blood supply of the AV node?
   c. What is the blood supply of the SA node?
   d. List 3 manifestations of myocardial ischemia in a patient under general anesthesia.
   
8. What are the determinants of blood pressure?
9. What are the determinants of cardiac output?
10. What are the determinants of oxygen content?
11. a. What are the determinants of oxygen delivery?
    b. What are the determinants of oxygen consumption?
    
12. What coronary artery and territory of the heart is monitored by leads II, III and AVF?
13. What coronary artery and territory of the heart is monitored by leads V4 and V5?
14. What coronary artery and territory of the heart is monitored by lead I and AVL?
15. List 3 important considerations for anesthesia in patients with mitral stenosis.
16. List 3 important considerations for anesthesia in patients aortic stenosis.
17. List 3 advantages of using opioids such as fentanyl for cardiac anesthesia.
18. List 3 disadvantages of using opioids such as fentanyl for cardiac anesthesia.
19. What is the mechanism of action of nitroglycerin in patients with myocardial ischemia?
20. What are the main indications for inserting a pulmonary artery catheter (PAC)?
21. What parameters can be measured and calculated from a pulmonary artery catheter?
22. a. List 5 clinical situations which might lead you to not insert a PAC in a patient meeting the criteria in questions #20, assuming easy cannulation of a central venous route.
    b. List 5 clinical situations which might lead you to not insert a right internal jugular cannula in a patient meeting the criteria in question #20.
    
23. Describe the anatomical location of the internal jugular vein.
24. What is the mechanism of action of heparin?
25. What is the mechanism of action of protamine?
26. List 3 side effects of protamine.
27. What does the ACT measure?
28. What does the PT measure?
29. What does the PTT measure?
30. List 5 essential components of the cardiopulmonary bypass circuit.
31. List 5 essential tasks to perform before and immediately after initiating bypass.
32. List 5 causes of hypotension during initiation of bypass.
33. What is the significance of cardiopulmonary bypass time.
34. What is significance of aortic cross clamp time.
35. List 5 essential tasks to perform before discontinuing cardiopulmonary bypass (besides ventilation, oxygenation and ensuring adequate HR and rhythm)
36. What is the therapy of low BP, CVP, PAP and CO?
37. What is the therapy of low BP, high PAP, low CO?
38. What is the therapy of high BP, low CO, normal PAP?
39. List 3 advantages and 2 disadvantages of dobutamine.
40. List 2 advantages and 2 disadvantages of epinephrine.
41. List 2 advantages and 2 disadvantages of norepinephrine.
42. List 2 advantages and 2 disadvantages of milrinone.
43. List 2 advantages and 2 disadvantages of calcium chloride.
44. List 2 advantages and 2 disadvantages of using volatile inhalational anesthetics during cardiac anesthesia.
45. List 2 advantages and 2 disadvantages of using benzodiazepines for cardiac anesthesia
46. List 2 advantages and 2 disadvantages of hypothermia during cardiopulmonary bypass.
47. a. What is significance of acute hypokalemia after cardiopulmonary bypass?
    b. What level of hypokalemia requires treatment after bypass?
    c. List 3 ECG signs of hyperkalemia
    d. List 3 methods to treat acute hyperkalemia (drugs and dose, in order of onset time from fastest to slowest).
    
48. List conditions that decrease Sv02.
49. List conditions that may predispose to pulmonary artery rupture in a patient with a PAC.
50. List conditions that may predispose to massive air embolism during and after bypass.
51. a. List conditions that may mimic severe bronchospasm after bypass.
    b. List methods to treat confirmed severe bronchospasm after bypass.