24 CHRONIC PULMONARY DISEASE

Question 1

1. What are some examples of obstructive pulmonary disease?

Question 2

2. What is obstructive pulmonary disease

Question 3

3. Why does arterial hypoxemia occur in patients with obstructive pulmonary disease?

Question 4

4. Why does carbon dioxide retention occur in patients with obstructive pulmonary
   disease?

Question 5

5. What are common physical, radiographic, and functional findings in patients with
   obstructive pulmonary disease?

Question 6

6. What characterizes asthma?

Question 7

7. How is the diagnosis of asthma made?

Question 8

8. What are some of the physical examination findings noted in patients with asthma
   during periods of normal pulmonary function? What are some of the physical
   examination findings noted in patients with bronchial asthma during periods of
   exacerbation of their asthma?

Question 9

9. What are some findings found in the pulmonary function studies and flow-volume
   loops during asthma exacerbations?

Question 10

10. What agents are commonly used for the chronic treatment of asthma?

Question 11

11. How can an acute asthmatic attack be treated?

Question 12

12. How should the patient with asthma be assessed preoperatively?

Question 13

13. How should a patient with asthma be assessed before a thoracic or abdominal
    procedure?

Question 14

14. Is regional anesthesia the preferred anesthetic choice in patients with bronchial
    asthma scheduled to undergo surgery on the extremities?

Question 15

15. What is the goal of the anesthetic management of patients with asthma?

Question 16

16. What agents may be used for the induction of general anesthesia in patients
    with asthma? What is an advantage and a disadvantage of ketamine for these
    patients?

Question 17

17. Which neuromuscular blocking drugs are associated with histamine release? What
    is the concern regarding the use of these neuromuscular blocking drugs in patients
    with asthma?

Question 18

18. What is the benefit of using a slow respiratory rate when mechanically ventilating
    the lungs of a patient with asthma?

Question 19

19. What is a benefit of maintaining adequate hydration intraoperatively in patients
    with asthma and chronic obstructive pulmonary disease (COPD)?

Question 20

20. What are the options for extubation of the trachea that will minimize the degree of
    airway hyperreactivity in response to manipulation of the endotracheal tube?

Question 21

21. How can the reversal of neuromuscular blocking drugs with anticholinesterases
    cause bronchospasm?

Question 22

22. Name five potential causes of intraoperative bronchospasm.

Question 23

23. How should intraoperative bronchospasm be treated?

Question 24

24. What characterizes pulmonary emphysema physiologically?

Question 25

25. What characterizes chronic bronchitis physiologically?

Question 26

26. How do emphysema and chronic bronchitis differ clinically?

Question 27

27. Why is the work of breathing increased in patients with pulmonary
    emphysema?

Question 28

28. For patients with COPD scheduled to undergo a surgical procedure, what should the
    preoperative evaluation include? When might preoperative pulmonary function
    tests be necessary?

Question 29

29. What are some pulmonary function test and arterial blood gas measurement
    results that indicate that the patient is at an increased risk of postoperative
    respiratory failure? What are some treatment interventions that may be warranted
    by the preoperative evaluation of the patient’s pulmonary function?

Question 30

30. What are the main considerations for the anesthetic management of patients with
    COPD?

Question 31

31. What are some potential disadvantages of using nitrous oxide as part of a general
    anesthetic in patients with COPD?

Question 32

32. What are two methods by which anesthesiologists may minimize the drying of
    secretions in the airways of patients with COPD in the intraoperative period?

Question 33

33. What ventilatory settings are appropriate for intraoperative mechanical ventilation
    of the lungs of patients with COPD?

Question 34

34. What characterizes chronic bronchitis physiologically? What is the major
    predisposing factor to the development of chronic bronchitis?

Question 35

35. What is the impact of COPD on the postoperative course?

Question 36

36. What is the clinical significance of an exacerbation of COPD, and what is its
    implication on an upcoming surgical procedure?

Question 37

37. How is pulmonary hypertension defined? What is the most common form of
    pulmonary hypertension?

Question 38

38. What are the physiologic effects of pulmonary hypertension?

Question 39

39. How can pulmonary hypertension affect the performance of the left ventricle?

Question 40

40. What are the main anesthetic considerations for patients with pulmonary
    hypertension?

Question 41

41. Is obstructive sleep apnea a rare or common disease?

Question 42

42. What are the physiologic characteristics of sleep apnea that may affect anesthetic
    management and outcome?

Question 43

43. What are the main anesthetic implications of obstructive sleep apnea?

Question 44

44. What are some preoperative considerations for the patient scheduled to undergo
    thoracic surgery?

Question 45

45. What are some specific preoperative history and physical examination findings that
    are indicative of an increased risk of postoperative pulmonary complications
    after thoracic surgery?

Question 46

46. What are some preoperative prophylactic measures that may be taken in an attempt
    to minimize postoperative pulmonary complications?

Question 47

47. How does cigarette smoking affect the lungs physiologically?

Question 48

48. What is the benefit of the preoperative cessation of cigarette smoking? After
    what duration of time after the cessation of smoking are these benefits noted
    to occur?

Question 49

49. For which patients are preoperative pulmonary function tests indicated?

Question 50

50. What values derived from pulmonary function tests are indicative of an increased
    risk of postoperative pulmonary morbidity after a pneumonectomy?

Question 51

51. What are PPO FEV1 (predicted postoperative FEV1) and PPO – DLCO (predicted
    postoperative DLCO)?

Question 52

52. What are some benefits of the administration of volatile anesthetics for patients
    undergoing thoracic surgery?

Question 53

53. What is a disadvantage of the administration of nitrous oxide for patients
    undergoing thoracic surgery?

Question 54

54. What is a benefit of the administration of nondepolarizing neuromuscular blocking
    drugs for patients undergoing thoracic surgery?

Question 55

55. What are some absolute indications for one-lung ventilation during surgery and
    anesthesia? What are some relative indications for one-lung ventilation during
    surgery and anesthesia?

Question 56

56. What is the most frequently used double-lumen endotracheal tube used for the
    isolation of the right or left lung or for one-lung ventilation during thoracic
    surgery?

Question 57

57. What is the potential problem with an endobronchial tube placed in the right
    bronchus for isolation of the right lung? How can this problem be avoided?

Question 58

58. What size double-lumen endotracheal tube is usually appropriate for adult patients?
    What depth in centimeters typically places the endobronchial tube in approximately
    the correct position in most adult patients of average height?

Question 59

59. What is the technique for placement of a left-sided double-lumen endotracheal
    tube? How is the proper placement of a double-lumen endotracheal tube best
    confirmed?

Question 60

60. What is the single-lumen Univent tube? What is its potential advantage for
    ventilation?

Question 61

61. What is a Arndt endobronchial blocker?

Question 62

62. What is a Cohen tip deflecting endobronchial blocker?

Question 63

63. How does a bronchial blocker compare to a double-lumen endotracheal tube?

Question 64

64. How does the lateral decubitus position during mechanical ventilation of the lungs
    affect the ventilation-to-perfusion ratio in the lungs?

Question 65

65. What are four factors that influence the amount of perfusion that goes to the
    nondependent, unventilated lung during ventilation of a patient in the lateral
    decubitus position with a double-lumen endotracheal tube?

Question 66

66. What are the interventions that can be made when arterial hypoxemia is noted in
    a patient during ventilation for thoracic surgery?

Question 67

67. Why is the placement of chest tubes after thoracic surgery necessary
    postoperatively?

Question 68

68. When should extubation of the trachea after thoracic surgery occur?

Question 69

69. What are the common postoperative pulmonary complications after thoracic
    surgery?

Question 70

70. What is the importance of adequate analgesia after thoracic surgery?

Question 71

71. What is the most frequent reason for the performance of a mediastinoscopy?

Question 72

72. What are the complications associated with mediastinoscopy?