Anesthesia for Thoracic Procedures - Final Wrapup Flashcards
What is the FVC for High Risk Patients?
< 50%
What is the FEV1 for High Risk patients?
< 2L
What is the FEV1 / FVC for High Risk patients?
< 50%
What is the RV/TLC for High Risk patients?
> 50%
What is the Diffusion Capacity for High Risk patients?
< 50% predicted
What are the Intrinsic PFT changes for a pt w/ Restrictive Lung disease?
↓FVC
Everything else stays normal
What are the Extrinsic PFT changes for a pt w/ Restrictive Lung Disease?
↓FVC
↑RV/TLC
Everything else normal
What are the PFT Changes for pts w/ Obstructive Lung Disease such as Asthma, Bronchitis, and Emphysema?
↓FEV1
↓FEV1 / FVC
↑RV / TLC
Normal FVC
What does Pulm. HTN look like on a Chest X-Ray?
Dilated Pulm. Vessels
COPD - Hyperinflated w/ Low Flat Diaphragm
RVH - Clockwise Cardiac Rotation w/ Loss of Air Space behind sternum
What should pts be instructed to do before Thoracic Surgery?
Stop Smoking
Breathing Exercises
Mucolytics/Expectorants
Bronchodilation Meds
Lose Weight
What are some meds that cause Bronchodilation?
Aminophylline - PDE Inhibitor increases cAMP
Cromolyn Sodium - Mast cell Stabilizer
Parasympatholytics
Sympathomimetics
How do Sympathomimetics cause Bronchodilation?
Beta Agonists increases cAMP
Metaproterenol
Albuterol
Terbutaline
How do Parasympatholytics help w/ Bronchodilation?
Decreases cGMP, which causes Bronchoconstriction
Atropine
Ipratropium Bromide
Which med is useful for Left-sided HF or SVT?
Digitalis
In the Lateral Decubitus Position, which Lung is better Perfused?
Down Dependent Lung
In the Lateral Decubitus Position, which Lung is better Ventilated?
Up Non-Dependent Lung
What are the Advantages of the Lateral Decubitus position for Thoracic Surgery?
Hemithorax Access
Easy to Extend Incision
Easy to Tilt Pt.
Safest for Hilar Dissection
Control of Hilar Vessel
What are Disadvantages to the Lateral Decubitus Position for Thoracic Surgery?
Opposite Hemithorax Inaccessible
V/Q Mismatch
Down Dependent Lung Contamination
↓FRC, Airway Closure, Atelectasis of Down Lung
Positional Injury
How can the Lungs be Separated?
Doubel Lumen ETT
Univent ETT
Bronchial Blockers
When is Lung Separation Absolutely Indicated?
Prevent Cross Contamination
Ventilation Redistribution
Unilateral Bronchopulmonary Lavage
What anesthetic should be avoided in one Lung Anesthesia?
N2O
How should Hypoxia during One Lung Ventilation be managed?
- CPAP to Up, Non-Dependent, Deflated, Operative Lung
- PEEP to Down, Dependent, Lung
- Return to 2 Lung Ventilation
- Ask MD to clamp Rt. Pulm. Artery
What are Contraindications to a Double Lumen ETT?
Lesions
Difficutly getting Direct Vision Intubation
Pts who cant tolerate Apnea
Full Stomach
What are the concerns w/ Rigid Bronchoscopy?
Shared Airway
Arrhythmias
HTN
Hypoxemia
What should be evaluated in regards to Rigid Bronchoscopy?
Lesion Level
Ischemic Processes
Lung Sounds
What type of meds should be used for Rigid Bronchoscopy?
Robinul
&
Short Acting Anesthetics
What are the Absolute Contraindications for Fiberoptic Bronchoscopy?
Unstable CV System
Life-Threatening Arrhythmias
Severe Hypoxemia
What is to be expected w/ Fiberoptic Bronchoscopy?
Coughing
HTN
Tachycardia
What size should the ETT be if a Fiberoptic Bronch is going thru the ETT?
7.5 - 8.0
What size should the ETT be if a Fiberoptic Bronch is going Next to the ETT?
5.0 - 6.0
What is Eaton-Lambert Syndrome?
Muscle Wasting
What should be expected w/ Pneumonectomies?
Unrecognized Blood Loss
Post-Op Pulm. Edema & Atelectasis
Dysrhythmias
DVT/PE
Persistent Air Leak
What can be a Life Threatening complication of a Pneumonectomy?
Excessive Mediastinal Shift
What are signs of an Ipsilateral Mediastinal Shift r/t a Pneumonectomy?
Hypotension
Arrhythmias
Cardiac Herniation
Pulm. Edema
What are signs of a Contralateral Mediastinal Shift r/t a Pneumonectomy?
↓Lung Function
&
↓Venous Return
How should Chest Tubes be managed to Prevent Mediastinal Shifts?
Keep Clamped w/ Brief Unclamping to Drain
