Anesth. for Thoracic Surgery Flashcards
Wiggly-arm's powerpoint on thoracic surgery. Pretty much all the crap on the slides.
6 disease states that would require thoracic surgery?
- lung tumors
- esophageal disease
- mediastinal tumors
- infection
- bronchiectasis
- thoracic aneurysms
Name 2 endoscopy procedures and 2 mediastinal procedures.
Endoscopy:
- bronchoscopy
- esophagoscopy
Mediastinal:
- mediastinoscopy
- thymectomy
Should you put in an A-line for all major thoracic surgeries?
yes, yes you should.
What type of anesthesia can be done for a bronchoscopy with a flexible scope? How about with a rigid scope?
MAC or GETA for flexible scope
GETA for a rigid scope
What are some complications that can occur from endoscopic procedures? (4, or so)
- facial, dental, laryngeal injury
- airway rupture, pneumothorax
- hemorrhage
- airway obstruction – blood, FB, edema
What are some things to consider when doing an endoscopic procedure? (7)
- Small ETT vs. Double-lumen tube
- Laser tube and laser precautions
- Short-acting hypnotic agent
- Inhaled agents vs TIVA
- Short-acting narcotics
- Short-acting muscle relaxant
- Local anesthesia – post-op
What are the two types of approaches for a mediastinoscopy?
cervical
anterior (Chamberlain procedure)
What are complications associated with mediastinoscopy procedures? (7)
- # 1 Rupture/laceration to major vessels
- # 2 Pneumo (Hemo)-thorax
- Intermittent occlusion of R innominate artery
- Tracheal collapse
- Tension pneumomediastinum
- Mediastinitis
- Chylothorax
Surgeries that require a median sternotomy? (3)
- Thymectomy
- Mediastinal masses
- Sternotomy for Bilateral Pulmonary Resection
Thymectomy is the treatment of choice for what?
myasthenia gravis
autoimmune disease that causes a decrease in the number of post-junctional ACh receptors
Should a myasthenia gravis patient hold their anticholinesterase medications on the day of surgery?
yes
What is different about the Eaton-Lambert Syndrome from traditional myasthenia gravis?
Easton-Lambert Syndrome is an autoimmune disorder that causes a pre-junctional decrease in ACH release. It does not affect the receptors.
In these patients, the symptoms will improve with exertion.
Things to consider prior to anesthesia for mediastinal masses. (5)
- Degree of functional impairment
- Orthopnea
- Supine & upright PFT’s
- Specific CT report/examination
- Close communication with surgeon
Things to consider for a dynamic airway obstruction. (3)
- Position/muscle tension dependent
- Fine with upright/spont vent, dead with supine & relaxed
- What if you can’t ventilate even with properly placed ETT? –> Rigid bronch emergently, position change, spont vent
Name a few open thorax procedures. (8 referenced in his slides)
- Lung Biopsy/Pleurodesis
- Lung Resection (W<p></p>
What are 4 indications for lung isolation?
- control of foreign material (lung abcess, hemoptysis, etc)
- airway control (bronchopleural-cutaneous [B-p] fistula)
- surgical exposure (lung resection, VATS, etc.)
- special procedures (lung lavage, differential ventilation)
Things to consider during the preop evaluation for lung isolation procedures. (5)
- Laboratory Tests
- Prescreen for underlying pulmonary infection,
- Tracheal stenosis (positional dyspnea, airway collapse, hypoxemia, anatomic narrowing)
- Review ABG, PFT, CXR, V/Q Scan, CT/MRI (lesion and trachea), angiography
- Coexisting pathology
If a patient is having a lung procedure done and their Hct is < 25%, should they be transfused?
yes, because adequate oxygen carrying capacity is essential.
also, type and cross for 2-4 units of PRBC
Lung cancer patients could potentially have myasthenic syndrome, which means they could have an increased sensitivity to what type of drugs?
nondepolarizing muscle relaxants
GETA with or without a thoracic epidural can be used for lung surgeries. Epidural analgesia reduces VAA requirements, but the epidural anesthesia may create ________ _________ and __________ .
sympathetic blockade
hypotension
What are 3 complications in open thoracic surgery?
- pneumothorax (from opening the chest)
- interference with ventilatory exchange and CV stability d/t manipulation of lung, heart, and major vessels
- alteration of the distribution of blood flow to the lungs d/t lateral decubitus position, exposing the lower lung to danger of contamination by secretions, blood, or fluids
What are 7 risks to open thorax surgery?
- Dysrhythmias #1!!
- DVT/PE/AMI
- Bronchopleural fistula
- Chylothorax
- Subcutaneous emphysema
- Phrenic nerve injury***
- Recurrent laryngeal nerve injury
What is pleurodesis?
Pleurodesis is a procedure used to cause the layers of the lung lining (the pleura) to stick together. A chemical or medication is inserted into the space between the 2 layers of the pleura, causing inflammation that effectively glues the layers together.
What is decortication?
Decortication is a surgical procedure that removes a restrictive layer of fibrous tissue overlying the lung, chest wall, and diaphragm. The aim of decortication is to remove this layer and allow the lung to reexpand. When the peel is removed, compliance in the chest wall returns, the lung is able to expand and deflate, and patient symptoms improve rapidly.
