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Miller's Anesthesia > 53. Thoracic surgery > Flashcards

53. Thoracic surgery Flashcards

1
Q

Eaton lambert syndrome and cancer

A

Associated with small cell carcinoma

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2
Q

Cancer not related to smoking and characteristics

A

Carcinoid. Survival 90% (5Y)
No responsive to usual vasopressors. Tx Octreotide

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3
Q

Increase risk of desaturation in chest surgery if

A

Poor PaO2 during 2LV
Right thoracotomy
Normal spirometry o RLD
Supine
V/Q high

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4
Q

Adjustments in OLV

A

TV 5 - 6 mk/kg (IBW)
Peak p < 35, plateau > 25
PEEP 5 - 10 mmHg
RR 12 rpm

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5
Q

Best test for pulmonary mechanics

A

Predicated post op FEV1

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6
Q

Segments in lungs

A

Right. 6 - 4 - 12
Left 10 -10

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7
Q

Pre anesthesia in thoracic surgery

A

If METs > 2 spirometry (ppo FEV1, DLCO)
If METs < 2 Consultation + optimization

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8
Q

Post op predicted FEV1

A

> 60 ok
30 - 60 simple exercise test
< 30 cardiopulmonary testing
< 20 unacceptable

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9
Q

Arrhythmias after thoracic surgery (lung resection)

A

60 - 70 % afib
incidence 30 - 50%

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10
Q

Innominate artery characteristics

A

Brachiocephalic artery
Blood supply to the right arm. Pressure can cause desaturation and flat wave if pulsometer is in the right

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11
Q

Cardiac herniation carac.

A

50% death
Rupture of pericardium
< 24 h

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12
Q

Bronchopleural fistula carac.

A

Sudden onset of dyspnea
Subcutaneous emphysema
Contralateral deviation of trachea
Decrease fluid levels

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13
Q

Increase risk for thoracic surgery if

A

FEV1 (ppo) < 40. high < 30
DLCO < 40
O2 consumption < 15 ml/kg/min. < 10 very high

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14
Q

Double lung tube sizes

A

female < 160 35
>160 37
Male < 170 39
> 170 41

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15
Q

Absolute C.I lung transplant

A

Malignancy < 2y
Chronic d. HB…
Spinal chest deformity
Non adherence
Substance addiction
Psychotic disorder

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16
Q

Toxicity of chemo

A

Cisplatin Renal
Bleomycin Lung
Doxorubicin Cardiac

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17
Q

Massive hemoptysis if blood loss

A

> 200 ml

18
Q

Complication in thoracic surgery

A

15 - 20% resp
10 - 15 cardiac
4 death

19
Q

Pulmonary Hypertension carac

A

Avoid hypotensive drugs
Ketamine ok (doesn’t exacerbate)
Ephedrine, Vaso, phenilep, OK
Use inhaled vasodilators
Thoracic epidural with caution

20
Q

DLCO FEV1 and chemo

A

Chemo affects DLCO, no FEV1

21
Q

Lower limit in FEV1 or DLCO for surgery

A

Patient with < 20 not candidate

22
Q

HyperK and HyperNa, cancer

A

Squamous CC

23
Q

Perioperative risk in thoracic surgery by test

A

< 15 l/kg/min high risk , 10 very high
6MWT 450 = 15
Shuttle WT 250 = 10
Increase risk if SPO2 in exercise spirometry increase more than 4%

24
Q

Extubation criteria after thoracic surgery

A

FEV1 > 40%
FEV1 > 30% and exercise tolerance good (6MWT > 450m)
FEV1 > 20 in VATS and good tolerance

25
Q

Incidence of heart ischemia after thoracic surgery and when

A

5%
POD 2-3

26
Q

Treatment to prevent Afib

A

Diltiazem

27
Q

Patient with pulmonary hypertension. What drugs to avoid

A

Dobutamine and milrinone, decrease SVR and increase HR

28
Q

Age, preoperative assesment and thoracic surgery

A

If more than 70 Echo
If normal surgery (and no DM, CHF o IHD)
If no normal Dobutamine stress echo. If no normal also angiography

29
Q

COPD staging

A

1 >50% FEV1
2. 35-50
3. <35%

30
Q

Lung cancers

A
31
Q

Most common complications during thoracic surgery

A
  1. Hypoxemia
  2. Sudden severe hypoT
  3. Changes in ventilation
  4. Arrithmias
32
Q

Single and DL tubes relationship

A

7.0 - 28
8.0 - 35
9.0 - 37
10 - 41

33
Q

Position of DL tube

A

Heightx10 +12

34
Q

Indication for Right DL tube

A
35
Q

Airway bronchoscope view

A

Left. LLL + LUL (2 branches after)
Right. RUL 3 branches + RML + RLL

36
Q

Minimal length of exchange cathether

A

83 cm

37
Q

French for exchange cathether

A

35-37 11
39-41 14

38
Q

Maximum depth exchange catheter

A

24 cm

39
Q

Segments in the lungs

A

RUL 3
RML 2
RLL 5
LUL 4
LLL 4

40
Q

Dependent vs non dependent lung

A

Dependent ventilated. Down

41
Q

Most common injury in legs in side surgery

A

Dependent peroneal nerve
Non dependent (up) sciatic nerve

Miller's Anesthesia (43 decks)

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