1. Respiratory Obstructive Flashcards
Obstructive TLC
increased
obstructive RV
incereased
obstructive FEV1
decreased
Obstructive FVC
decreased
obstructive FEV1/FVC
decreased
compliance =
C= V/P
the supine position _______ FRC
decreases
does anesthesia change airway resistance
no NET change
– atelectasis: incr R
– VA bronchodilation: decr R
common obstructive diseases (5)
URI
Asthma
COPD
Bronchiectasis
Cystic fibrosis
what percentage of URI are viral
95% are nasopharyngitis
viral URI
non-productive cough
sneezing
rhinorrhea
bacterial URI
fever
purulent drainage
productive cough
malaise
which type of URI has a higher rate of post-op complications
bacterial
COLDS scoring
Current symptoms
Onset of symptoms
Lung disease
airway Device
Surgery
how long from symptom onset are you most at risk for anesthetic complications with a URI
less thatn 2 weeks from symptom onset
which airway device has a higher risk with URI
ETT
how long should you wait for a non-urgent surgery in pts with URI
6 weeks from start of symptoms
asthma
reversible airway obstruction due to inflammation
asthma pt factors
genetic
environmental
maternal smoking during preg
limited exposure to infectious enviro
asthma trigger
allergen
NSAIDs
infections
excercise
endorphin/vagal mediated
asthma inflammatory cascade
histamine
prostaglandin D2
leukotrines
asthma clinical signs
expiratory wheeze
cough
dyspnea
chest tightness
eosinophilia (labs)
severe asthma
FEV1
FEV1/FVC
FEV1<60%
FEV1/FVC: decr by 5+%
asthma flow-volume loop
scooping/concave
status asthmatics
life threatening bronchospasms that persist with treatment
status asthmaticus treatment
high does beta2 agonists
corticosteroids
anticholinergics
IV Mg2+
IV epi
supp O2
volatile agents (bronchodilation)
ECMO
what predicts increased risk for PRAE in asthmatic pts
FVC and FEV1 <70%
which opioid produced histamine
morphine
emergence in asthmatic pts will be _________
slower
COPD PFTs
FEV1:FVC
FEF
FRC
TLC
RV
FEV1:FVC < 70%
forced exp flow: 25-75% of VC
incr FRC
incr TLC
incr RV
mild COPD
FEV1 >= 80%
mod COPD
FEV1 betwee 50-80%
severe COPD
FEV1 between 30-50%
very severe COPD
FEV1 <30%
BODE index
BMI
Obstruction degree
Dyspnea level
Exercise tolerance
high BODE score
greater risk of COPD exacerbations, hospitalizations, and death
COPD blood tests
alpha1 antitrypsin definciency
increased eosinophiles
ABG PaO2 decreases w/severe
COPD treatment
1st line: muscarinic antagonist
2nd: beta2 agonist
3rd: glucocoricoids
should pts take COPD meds day of surgery
yes
COPD pre-op
smoking cessation > 6 weeks
medication
alb >3.5 mg/dL
pre-op incentive spirometry
what is the most important factor to decrease COPD risk pre-surgery
incentive spirometry
COPD blocks to avoid
above T6
interscalene block
can you use N2O with COPD pts
no
may rupture bullae and cause a pneumothorax
mech ventilation goals: COPD
avoid dynamic hyperinflation/auto-peep
will incr intrathoracic pressure
air trapping detection
upsloping capnography
flow doesnt go to 0 before inhalation
air trapping intervention
decr RR
incr expiratory time
bronchospasm treatment
propofol
incr gas
albuterol
epi
bronchiectasis
irreversible airway dilation
inflammation
chronic bacterial infection
bronchiectasis symtpoms
cough w/purulent sputum
dyspnea
wheezing
pleuritic chest pain
clubbing of fingers
gold std for bronchiectasis diagnosis
CT
bronchiectasis treatment
chest physiotherapy
abx
bronchodilators
steroids
bronchiectasis management
suction ETT frequently
cystic fibrosis anesthetic managment
VA
high FiO2
avoid anticholinergic
suction ETT frequently
