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adv princip II exam 2 (6/13) > anest 4 thoracic surg 1/3 pp 29-45 > Flashcards

anest 4 thoracic surg 1/3 pp 29-45 Flashcards

0
Q
  1. what is ERV

2. how much is it?

A
  1. expiratory reserve volume or the maximum volume of gas that can be exhaled after a tidal exhalation
  2. approx 1.5 L
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1
Q
  1. what is IRV

2. how much is it?

A
  1. inspiratory reserve volume i.e. the amount of gas that can be inhaled after a normal (tidal) inhalation
  2. approx 3 L
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2
Q
  1. what is VT

2. how much is it?

A
  1. tidal volume or the amount breathed in and out during normal respiration
  2. aprox 500 ml
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3
Q
  1. what is RV

2. how much is it?

A
  1. residual volume or the amount of air that stays in the lungs no matter what you do
  2. approx 1 L
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4
Q
  1. what is the FRC?

2. what makes up the FRC?

A
  1. the volume of gas remaining in the lungs at the end of a normal exhalation (measured by N2 washout)
  2. expiratory reserve volume and residual volume (ERV & RV)
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5
Q
  1. what is the IC?

2. what makes up the IC?

A
  1. inspiratory capacity (the maximum amont of gas that can be inhaled after a normal EXHALATION
  2. IRV & VT
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6
Q
  1. what is VC?

2. what makes up VC?

A
  1. vital capacity; is the volume of gas that can be forcibly exhaled after maximum inhalation (i.e. max exhale post max inhale)
  2. IRV, VT, ERV
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7
Q

what is a normal TLC (total lung capacity)?

A

6 liters

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8
Q

what effect do obstructive diseases have on volume and capacity?

A
  • elevated TLC (increases from 6-8L d/t trapped air)
  • elevated FRC (d/t increased RV)
  • if increase in FRC and RV are severe, may start to subtract from VC (vital capacity)
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9
Q

restrictive lung disease effects on lung volume and capacities

A
  • decreased VC (decreases 80% from ~4L to ??) d/t decrease in IC
  • decreased TLC and normal or decreased FRC
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10
Q

what are examples of restrictive disease?

A
  • loss of parenchyma (from:fibrosis, massive pneumonia, lobectomy)
  • chest wall issues (from: pregnancy, obesity, ascites, pleural effusion kyphoscoliosis)
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11
Q
  1. what is expiratory flow largely dependent on?
  2. what does this mean?
  3. what diseases will have a reduction in flow
A
  1. expiratory flow is dependent on recoil force and caliber of airway
  2. maximum flows will be higher at higher lung volumes
  3. diseases in which parenchyma is destroyed will have reduction in flow (emphysema)
    - diseases which affect airway caliber/diameter (asthma, bronchitis)
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12
Q
  1. what is forced vital capacity?
  2. what is a normal FEV1?
  3. what does that tell us?
A
  1. the amount of air that can be exhaled in 1 second (FEV1) and 3 seconds (FEV3)
  2. should be 70-80% within 1 second (FEV1)
  3. degree of airway obstruction and responsiveness to bronchodilators
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13
Q
  1. what are expiratory flow-volume curves?
  2. what does flow-volume measure?
  3. what does pressure-volume measure?
A
  1. plot airflow against volume
  2. flow-volume measures airway resistance (RAW) (f-v-r)
  3. pressure-volume measures compliance (p-v-c)
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14
Q

what is a flow time diagram used for?

A

adjusting I:E ratio (to ensure that air is completely blown out before the next breath comes in)

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15
Q

what is closing volume and capacity?

A

the pressure needed to keep small airways open at the end of tidal volumes
2. if closing volumes increase, it takes more volume to keep small airways from closing and may even close at tida volumes (like in emphysema)

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16
Q
  1. how do upper and lower alveoli differ in expaision?

2. what does that say about which one is at higher risk of closing d/t surface tension?

A
  1. upper alveoli expand more than lower alveoli,

2. smaller alveoli are more prone to closure than bigger ones

17
Q
  1. what is the formula for Alveolar-arterial pO2 difference?

2. what is a normal Alveolar-arterial pO2 difference?

A
  1. 140 - (paO2 + paCO2)
    ex: 140-(95 + 35)=
    140-130=10 mmHg
  2. should not be greater than 20 torr (mmHg)
18
Q

what explains an elevated A-a pO2 (of > 20 mmhg)?

A

venous admixture caused by:

  • VQ inequality
  • right to left intracardiac or intrapulmonary shunt
  • limited diffusion of O2
  • decreased ventilation
  • pulmonary parenchyma collapse
19
Q
  1. static compliance (Cst) measures what? what pressure is it associated with?
  2. what is normal value?
A
  1. measures recoil of the lungs and is defined as the volume change produced by a unit of pressure change
    - associated with plateau pressures which reflect compliance of chest wall and elasticity of lung tissue at point when no gas is flowing
  2. normally 0.2 L/cmH20
20
Q
  1. dynamic compliance (Cdyn) measures what?

2. what pressure is it associated with?

A
  1. measures pressure during breathing ans is affected by both recoil and RAW (resistance)
    - associated with PIP
21
Q

in normal adults Cdyn and Cst are what?

A

the same

22
Q
  1. what diseases cause a decrease of recoil that would increase the Cst?
  2. what value would they have?
A
  1. emphysema has decreased recoil d/t destruction of elasticity of parenchyma
  2. 0.35 L/cm
23
Q
  1. what is one predictor for post op pulmonary risk?
  2. what are the BEST predictors?
  3. what other test is a good predictor? what changes are higher risk?
A
  1. severity of lung disease
  2. site of surgery, age, obesity and smoking Hx are better predictors of post op pulmonary risk than severity of lung disease
  3. (PFTs) decreased FEV1 and FVC
24
Q

why might it be hard to get a pateint with respiratory disease deep enough with inhaled anesthetics to pervent bronchoconstriction during airway insturmentation?

A

poor lungs dont absorb gas as well

25
Q

what might someone with a decreased FEV1 be likely to develop if allowed to breathe spontaneously under anesthesia?

A

hypercapnea

26
Q
  1. what does anesthesia induction do to FRC?

2. what can this cause?

A
  1. reduces it (by 15-20%)so that airways do not remain open even during tidal breathing
  2. this can cause shunt effect and atalectasis
27
Q

what is the most common cause of hypoxia during anesthesia is…

A

failure to initiate or resume mechanical ventilation

28
Q

what are other causes of hypoxemia (in regards to oxygen) during anesthesia?

A
  • disconect of circuit (most preventable cause of morbidity)
  • empty o2 cylinder
  • non o2 cylinder in place of o2
  • erroneously filled 02 cylinder
  • pipeline supply failure
  • cylinder not open enough (gas cannot escape as pressure declines)
29
Q

causes of hypoxemia:

A
  1. failure of ETT (kinking, cuff herniation, blockage)
    - -mainstem bronchial intubation
  2. hypoventilation
    - from reduced lung compliance
    - increased resistance
    - surgical position limits excursion of chest
  3. hyperventilation
    - decreases paO2 d/t decreased C.O. and shift in oxy-hb dissociation curve
  4. decreased FRC
30
Q
  1. why is FRC important?

2. how long do the effects of decreased FRC last?

A
  1. is it the reserve of oxygen supplied to the pulmonary capillaries between breaths so a decrease in FRC can be detrimental
  2. decreased FRC can continue into the post op period until patient re-expands their own lungs
31
Q

hypercapnia during anesthesia?

–causes of increased dead space ventilation

A
  • decreased PAP (hypotension)
  • increased airway pressure (peep)
  • PE, vascular clamping
  • shallow/rapid inspirations (only move dead space air)
  • age related increases in dead space
  • mask and ett increase dead space
32
Q

how do you overcome increased deadspace?

A

increase VE (minute ventilation)

33
Q
  1. what is the normal ratio of dead space to VT?
  2. what is it with an ETT?
  3. what is with a face mask?
A
  1. .33
  2. .46
  3. .64
34
Q

what causes increased CO2 production?

A
  • shivering
  • catecholamine release
  • htn
  • thyroid storm
  • MH
35
Q

CO2 absorber malfunction

tx:

A

use fresh gas flow of higher than 5 to dilute inspired CO2

36
Q

causes of hypercapnea during anesthesia?

A
  1. increased dead space ventilation
  2. increased co2 production
  3. co2 absorber malfunction
37
Q

what are normal weaning parameters?

A
  • vital capacity of 15 ml/kg
  • vT of 5 ml/kg
  • NIP of -15 to -20 cmH20
38
Q
  1. what is a normal vital capacity?

2. how much is it reduced after abdominal or thoracic surgery? within what time frame?

A
  1. 55-85 ml/kg

2. it is reduced by 50-75% within 24 hours after thoracic or abdominal durgery

39
Q

what are the relative risk of post op pulmonary complications ratios ( X: normal)?

  1. abnormal PFT : normal PFT=
  2. abdominal operation : non abdominal=
  3. smoking : non smoker=
  4. older than 60 yrs: under 60=
  5. over weight by 20%: normal weight=
A
  1. abnormal PFT : normal PFT= 23:1
  2. abdominal operation : non abdominal= 4:1
  3. smoking : non smoker= 4:1
  4. older than 60 yrs: under 60= 3:1
  5. over weight by 20%: normal weight= 2:1
40
Q

SMOKING CESSATION:

  1. what is half life of nicotiene
  2. How long does it take for sputum to reach normal post smoking cessation?
  3. how long after smoking does it take for carbon monoxide levels to reach normal?
A
  1. 30-60 min
  2. 2-6 weeks
  3. 12-48 hours (thereby increasing O2 carrying capacity)

adv princip II exam 2 (6/13) (5 decks)

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