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Medical Nursing > Anaesthesia for thoracic surgery > Flashcards

Anaesthesia for thoracic surgery Flashcards

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1
Q

What are important pre-anaesthetic considerations for thoracic surge patients?

A

Actelectasis (collapsed lung)
Decreased TLC VC FRC
Ventilatroy mechanism
Very painful procedure

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2
Q

What are the three methods of carrying out thoracic surgery and how are they related to pain?

A

Lateral thoractotomy
Vertical incision, potential rib resection (more painful involves retraction)
Sternotomy
Incision on the sternum accesse to whole cavity
Thorascopy
Abdominal approach (least invasive and painful)

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3
Q

Why is thoracic surgery so painful?

A 
Skin incision
Nerve damage 
Intercostal and phrenic 
Retraction 
Inflammation 
HYPERALGESIA 
Unable to immobilise the chest after surgery
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4
Q

What respiratory conditions are corrected in thoracic surgery and what complications may the present with?

A 
Lung lobe torsion 
Bulla,
Neoplasia, 
Abscess 
(Pre-existing pneumothorax, hypo ventilation , hypoxaemia)
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5
Q

What cardiovascular conditions are corrected via thoracic surgery and what complications may be presented?

A

PDA, PRAA, pericardiectomy,
Heart surgery
( bleeding, hypotension, arrhythmias)

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6
Q

Other thoracic surgeries that are not for respiratory or cardiovascular issues and their complications?

A

Vascular ring, thoracic duct ligation, oesophageal surgery

Regurgitate, aspiration, sepsis

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7
Q

What are the classic problems during thoracic surgery?

A

Blood loss (PDA, PRAA)
Hypotension
Hypoventillation

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8
Q

What must you always do before surgery commences?

A

Be prepared
Blood type
Check equipment

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9
Q

What steps should you take to stabilise the patient before surgery?

A

Pre-oxygenate avoid stress
Place chest drain
Minimise respiratory depression

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10
Q

What should the anaesthetic protocol depend on?

A

The ASA status of the patient

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11
Q

What are the main aims of the anaesthetic protocol and what drugs should be used to achieve this?

A 
Minimal cardiovascular and respiratory depression 
Especially in PDA 
Alpha 2 small volume for sedation 
Etomidate (highly compromised) 
Titration 
Analgesia!! (CRI fentanyl) 
Multimodal 
Cardiovascular drugs Dobuta one
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12
Q

Discuss the anaesthetic protocol of the thoracic patient to minimise respiratory depression

A 
Do not deeply sedate patient as need them to move their chest wall 
Always give opioids 
Benzodiazepine (good with co-induction) 
ACP (long acting) 
Rapid intubation Iv induction
Alfaxalone/propofol + etomidate 
Ketamine 
Rapid recovery and elimination of drugs ( volatile agents)
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13
Q

What special requests may be asked of you in thoracic surgery?

A

One lung ventilation

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14
Q

What types of ventilation can be used and what are the advantages?

A

Manual
Mechanical(much less demanding)
Re deploy lungs gently at the end of surgery

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15
Q

What should the tidal volume be set at on a ventilator and how should it be monitored to ensure it ias adequate?

A 
10-15ml dog 
8-10ml cat
Observation of the thorax 
Adapt with monitoirng 
Intraop visualisation
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16
Q

What should peak inspiratory pressure be set at on a ventilator and how should it be monitored?

A

8-12cm H2O

Adapt to open and closed thorax

17
Q

What should respiratory rate be set to on a ventilator?

A

10-30bpm
Adapt to animal
Increase if Vt (tidal volume) is decreased

18
Q

What should the I:E ratio be set to on the ventilator?

A

1:2

Adapt according to the resp rate

19
Q

When should IPPV be stared?

A

Respiratory depression due to general anaesthetic drugs and analgesia
Due to decreased sensitivity to CO2
Hyperventilation decreaseing CO2 ( if not increase analgesic doses or midazolam

20
Q

What drugs can assist you when starting ventilation?

A 
NMB agents 
Atracurium 0.25-0.5 mg/kg Iv 
0.4mb/kg/h 
Monitoring 
Anatagoinsts edrophoium and atropine
21
Q

What are the risks of ventilation?

A 
Lung damage 
Lung rupture 
Cardiovascular depression 
Importance to monitor 
Reliability of equipmenT
22
Q

Why should the lungs be expanded slowly after collapsed for a long period of time?

A

Risk of pulmonary odema

23
Q

When should you stop ventilation?

A

End of surgery
Recruitment manoeuvre
Pulmonary re-expansion
(Incremental increases in volume/pressure)
Cannot do this is the lung has been collapsed for greater than 12hrs

24
Q

How do you stop ventilation?

A 
Stimulating respiratory function 
Decrease ippv 
Increased PAO2 
Decrease anaesthetic/analgesic drug 
Antagonise NMBA
25
Q

What monitoring should you use whilst ventilating a patient?

A

Capnography (limited reliability open thorax)
Paco2
SpO2
PaO2

26
Q

What other parameters should be considered when monitoring a thoracic patient?

A 
Fluid loss 
Haemorrhage 
Crystalloids colloids
Management of hypothermia 
Warming of lavage fluid
27
Q

What is an appropriate analgesia strategy for the thoracic patient?

A

Appropriate
Multimodal
Preventative
Analgesia

28
Q

What systemic analgesia drugs can be used for the thoracic patient?

A

Opioids (care respiratory depression, pain and dose)
Methadone 0.3mg/kg or 0.1mg/kg/hr
Fentanly 5mcg/kg + 5-10mcg/kg/hr
NSAIDS ( if normovolemic)
Ketamine (blous or CRI antihyperalgesia and supports cardiovascular system)
Lidocaine CRI better stability anti inflammatory

29
Q

What local solutions can be administered in the thoracic patient and how can they be given lost-op?

A

2 spaces before and 2 spaces behind the incision bupivicaine 0.5% 1mg/kg every 6 hours
Intercostal block
Bupivicaine stings on injection either give lidocaine first or given alongside bicarbonate
Epidural
LS morphine 0.1mg/kg + Nacl 1ml/3.5kg
Long action

30
Q

What should you monitor in recovery of a thoracic patient?

A 
Respiratory rate and effort 
SpO2 
MM and CRT 
Oxygenate 
Check chest drain 
Be ready to induce again
Consider blood transfusion if loss of blood 
Fluid therapy
31
Q

What must we consider when carrying out postoperative care for the thoracic surgery patient?

A 
Management hypothermia 
Nursing 
Padding and bladder 
Pain management 
(Multimodal titration to avoid excessive sedation)

Medical Nursing (22 decks)

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