Cvs Monitoring In Anesthesia

CVS MONITORING IN ANESTHESIA

Q. 1

About diagnosing air embolism with transesophageal echocardiography, which of the following is false:

 A

It can quantify the volume of air embolised

 B

It is a very sensitive investigation

 C

Continuous monitoring is needed to detect venous embolism

 D

Interferes with doppler when used together

Q. 1

About diagnosing air embolism with transesophageal echocardiography, which of the following is false:

 A

It can quantify the volume of air embolised

 B

It is a very sensitive investigation

 C

Continuous monitoring is needed to detect venous embolism

 D

Interferes with doppler when used together

Ans. D

Explanation:

D i.e. Interferes with Doppler when used together

  • Doppler modalities are generally available on modern trans esophageal echo systems to increase its effectivenessQ.
  • Trans Esophageal Echocardiography is the most sensitive investigation for diagnosing air embolismQ.
  • Continuous monitoring is required for detecting venous embolism.
  • It can quantify volume of embolism.
  • It is used in wide range of abnormalities including heart valve malfunction, endocarditis, evaluation of thrombus in left atrium, & congenital heart defects.

Q. 2

Which of the following is not a cardiovas-cular monitoring technique:

 A

Transesophageal echocardio- graphy

 B

Central venous pressure monitoring

 C

Pulmonary artery catheterization

 D

Capnography

Q. 2

Which of the following is not a cardiovas-cular monitoring technique:

 A

Transesophageal echocardio- graphy

 B

Central venous pressure monitoring

 C

Pulmonary artery catheterization

 D

Capnography

Ans. D

Explanation:

D i.e. Capnography 

  • Capnography is a respiratory monitoring system (not cardiovascular). It is the determination of end tidal CO2 (Et CO2) concentration to confirm adequate ventilation.
  • Cardiovascular monitoring techniques are – ECG, Echocardiography, BP, CVP, pulmonary artery catheterization.

Q. 3

Best to monitor intraoperative myocardial ischemia (infarction) is

 A

ECG

 B

CVP monitoring

 C

Transesophageal echocardiography

 D

Invasive intracarotid arterial pressure

Q. 3

Best to monitor intraoperative myocardial ischemia (infarction) is

 A

ECG

 B

CVP monitoring

 C

Transesophageal echocardiography

 D

Invasive intracarotid arterial pressure

Ans. C

Explanation:

C i.e. Transesophageal echocardiography 

Tranoesophageal echocardiography provides a real time picture of all 4 cardiac chambers and valves. It can identify any malfunctioning valves in addition to any wall motion abnormalities related to myocardia ischemia. It is very useful during anesthesia. Abnormal motion of ventricular wall detected in this way is a reliable index of myocardial ischemia and may guide drug therapy, can identify if therapy has successfully treated the ischemia or indicate the need for further surgical revascularization

CVP (catherter in central vein) measures right sided filling pressure whereas pulmonary artery catheter measures/monitors left heart filling pressure.

Arterial cannulation measures direct systemic arterial pressure and facilitate sampling of arterial blood for analysis.

Quiz In Between


Q. 4

While introducing the Swan-ganz catheter, its placement in the pulmonary artery can be identified by the following pressure tracing:

 A

Diastolic pressure is lower in PA than in RV

 B

Diatolic pressure is higher in PA than in RV

 C

PA pressure tracing has diacrotic notch from closure of pulmonary valve

 D

RV pressure tracing for plateau and sharp drop in early diastole

Q. 4

While introducing the Swan-ganz catheter, its placement in the pulmonary artery can be identified by the following pressure tracing:

 A

Diastolic pressure is lower in PA than in RV

 B

Diatolic pressure is higher in PA than in RV

 C

PA pressure tracing has diacrotic notch from closure of pulmonary valve

 D

RV pressure tracing for plateau and sharp drop in early diastole

Ans. C

Explanation:

C i.e. PA pressure tracing has diacrotic notch from closure of pulmonary valve


Q. 5

Importance of CVP measurements is :

 A

Need for blood transfusion

 B

Assess amount of fluid to be given

 C

Need for inotropic support

 D

All

Q. 5

Importance of CVP measurements is :

 A

Need for blood transfusion

 B

Assess amount of fluid to be given

 C

Need for inotropic support

 D

All

Ans. A

Explanation:

A i.e. Need for blood transfusion


Q. 6

CVP denotes pressure of:           

September 2005

 A

Left ventricle

 B

Left atrium

 C

Right ventricle

 D

Right atrium

Q. 6

CVP denotes pressure of:           

September 2005

 A

Left ventricle

 B

Left atrium

 C

Right ventricle

 D

Right atrium

Ans. D

Explanation:

Ans. D: Right atrium

Central venous pressure denotes pressure in the great veins at their entrance into the right atrium and averages 4.6 mm Hg.

Pressure in larger veins outside thorax:5.5 mm Hg Pressure in the venules:12-18 mm Hg

Quiz In Between


Q. 7

Radial artery is cannulated to measure:

March 2013 (f)

 A

Heart rate

 B

Blood pressure

 C

CVP

 D

End tidal CO2

Q. 7

Radial artery is cannulated to measure:

March 2013 (f)

 A

Heart rate

 B

Blood pressure

 C

CVP

 D

End tidal CO2

Ans. B

Explanation:

Ans. B i.e. Blood pressure

Arterial cannulation

  • It is a commonly performed procedure in the management of patients who are critically ill.
  • An indwelling arterial catheter allows for continuous blood pressure (BP) monitoring, frequent blood sampling, and arterial blood gas measurement.
  • Arterial catheters can be placed at the bedside and have been found to be relatively safe, with a low incidence of serious complications.
  • Arteries used for catheterization include the radial, ulnar, brachial, axillary, femoral, posterior tibial, and dorsalis pedis.
  • Of these, the radial artery is most commonly used in both adults and children.
  • The radial artery is chosen primarily because of the superficial nature of the vessel and ease of maintenance of the site

Q. 8

CVP is usually measured in:      

September 2009

 A

Superior vena cava

 B

Right atrium

 C

Junction of superior vena cava and right atrium

 D

Subclavian vein

Q. 8

CVP is usually measured in:      

September 2009

 A

Superior vena cava

 B

Right atrium

 C

Junction of superior vena cava and right atrium

 D

Subclavian vein

Ans. A

Explanation:

Ans. A: Superior vena cava

CVP is usually measured in Superior vena cava with the catheter inserted into a large vein in the neck (internal jugular vein), chest (subclavian vein) or groin (femoral vein) known as central venous catheter (“central line”, “CVC”, “central venous line” or “central venous access catheter”)

It is used to administer medication or fluids, obtain blood tests (specifically the “mixed venous oxygen saturation”), and directly obtain cardiovascular measurements such as the central venous pressure, sometimes termed preload. Certain medications, such as inotropes and amiodarone, are preferably given through a central line

Site-Specific Complications

  • Femoral vein: The most potentially serious complication is inadvertent penetration of the peritoneal cavity or rectum. This complication can be avoided by ensuring the site of insertion is below the inguinal ligament and the needle is not directed too posteriorly or inserted too deeply.
  • Internal Jugular vein: Cannulation of the IJ vein is also relatively safe but less so than femoral vein cannulation. As previously described, inadvertent puncture of the carotid artery can be problematic. Accidental injury to the brachial plexus has also been described. The most important potential complication is accidental pneumothorax.
  • Subclavian vein: The location of the subclavian vein is such that it is possible for the needle to inadvertently penetrate the pleural space and create a pneumothorax. This complication occurs in up to 5% of attempted subclavian line placements. More skilled operators have a lower incidence of this complication, so subclavian cannulation is recommended only for those who have experience with this technique.

Q. 9

Most sensitive method of non invasive monitoring of cardio-vascular ischemia in perioperative period is ‑

 A

NIBP

 B

ECG

 C

Pulse oximeter

 D

lEE

Q. 9

Most sensitive method of non invasive monitoring of cardio-vascular ischemia in perioperative period is ‑

 A

NIBP

 B

ECG

 C

Pulse oximeter

 D

lEE

Ans. D

Explanation:

Ans. is ‘d’ i.e., TEE

  • Two dimensional TEE is the most sensitive method to detect myocardial ischemia and air embolism in peri-operative period.
  • Detection of regional wall motion abnormality a rapid and more sensitive indicator of myocardial ischemia than is the ECG
  • Decreased systolic wall thickening may be more reliable index for ischemia than endocardial wall motion abnormality alone

Quiz In Between



This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this:
Malcare WordPress Security