● trụ động mạch: cẳng tay xa động mạch trụ bề ngoài nằm giữa gân của flexor carpi ulnaris và flexor digitorum superficialis. - Nó đi qua bên dưới retinaculum flexor để hoàn thành bề mặt lòng bàn tay vòm. Thành phần trụ động mạch nhiều hơn đáng kể so với các bố trí hình tròn. - Chi nhánh sâu vào lòng bàn tay nơi mà nó tạo thành một hai mạch máu tiếp hợp với nhau với động mạch xuyên tâm để hoàn thành vòm lòng bàn tay sâu | CHAPTER 6 The anaesthesia science viva book Maintenance of SVR and diastolic blood pressure DBP If SVR falls then coronary diastolic perfusion may fail with disastrous consequences. Vasodilatation must be avoided and preload maintained to allow flow across the stenotic valve. This has obvious implications for the use of the many anaesthetic agents which decrease SVR including local anaesthetics used in subarachnoid and extradural block. Cardiopulmonary resuscitation in the presence of aortic stenosis and left ventricular hypertrophy is rarely successful. Maintenance of heart rate and rhythm Bradycardia will decrease CO but tachycardia is even more detrimental because it limits the time for diastolic coronary perfusion. Dysrhythmias including atrial fibrillation require urgent treatment but myocardial depressants such as p-adrenoceptor blockers are better avoided. IBE Prophylaxis is mandatory. See Mitral stenosis page 303. Patients with aortic stenosis can be very difficult to manage. Severe cases presenting for non-emergency surgery should be referred to a specialist centre for consideration of aortic valve replacement. Otherwise anaesthesia should include invasive monitoring of intra-arterial and CVP and it may be necessary to run a continuous infusion of vasopressor such as noradrenaline to ensure that SVR is maintained. Further direction the viva could take You will be doing well if you have exhausted the discussion above and so you could be asked about pulmonary stenosis. The condition is analogous to aortic stenosis. The symptoms of fatigue syncope dyspnoea on exertion and angina pectoris due to right ventricular ischaemia are similar as are the compensatory mechanisms. An initial dilatation of the right ventricle is followed by concentric hypertrophy. A slow heart rate allows increased ejection time. The rise in right ventricular end-diastolic volume and pressure RVEDV and RVEDP respectively leads to a decrease in ventricular compliance. In cases of severe .
