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Coexisting diseases > Asthma > Flashcards

Asthma Flashcards

1
Q

Asthma
➢Chronic inflammatory disorder of the airways characterized by increase responsiveness of the ___________ tree to a variety of stimuli
➢This disorder causes recurrent episodes of
● _______, Breathlessness, Chest tightness, Cough (night and early a.m. ), Variable airflow obstruction that is REVERSIBLE
●Tachypnea, Prolonged _______ phase, Fatigue

A
  • tracheobronchial
  • wheezing
  • expiratory
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2
Q

Pathophysiology of Asthma
➢Airway __________ and inflammation
➢Mediators include: all have been implicated as histologic mediators
➢ Eosinophils, mast cells, neutrophils, ________, basophils,T lymphs
➢Other probable mediators of acute __________
include: cytokines, interleukins, ________ acid metabolites (leukotrienes and prostaglandins),kinins, histamine, adenosine, and PAF

A
  • hyper-responsiveness
  • macrophages
  • bronchoconstriction
  • arachidonic
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3
Q

Pathophysiology of Asthma
➢Asthma creates airways that are:
●inflamed, ________, hypersensitive to irritant stimuli
➢ The degree of airway responsiveness and bronchoconstriction parallels the extent of __________

A
  • edematous

* inflammation

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4
Q

Asthma: Alterations in PFTs/Lung Volumes

  • Decreased ______
  • extent of decrease reflects severity of ______ obstuction
A
  • FEV1

* expiratory

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5
Q

Asthma: Blood Gas Alterations

  • In mild to moderate asthma FEV1 >50% predicted – PaO2 and PaCO2 _____
  • In fact, PaCO2 often decreased as a result of ______ (neural reflex to bronchoconstriction)
  • With severe asthma (FEV1 less than 25%) - PaO2 may be less than 60mmHg and ______ may develop
  • CXR = _______ of the lungs
A
  • normal
  • hyperventilation
  • hypercarbia
  • hyperinflation
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6
Q

Pharmacologic Management: Prophylactic Approach
Treat Underlying Inflammation
*Inhaled Corticosteroids: Decreases ______ and hyper-responsiveness
*Cromolyn
*Leukotriene _________
*Methylxanthines-phosphodiesterase inhibitors

A
  • bronchial mucosal inflammation

* inhibitors

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7
Q

Pharmacologic Management: Rescue Approach - Bronchodilators
*Beta-2 Adrenergic Agonists – albuterol, ________
- B-2 receptor activation of adenylate cyclase with increased _____
concentrations & bronchodilation
- SNS side effects: tachycardia, dysrhythmias, _____ shifts

A
  • terbutaline
  • cAMP
  • potassium
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8
Q

Pharmacologic Management: Rescue Approach - Bronchodilators (con’t)

  • Anticholinergic Drugs – ________
  • Block muscarinic receptors = _______
  • Less effective than B-2 in asthmatics
A
  • ipratropium

* bronchodilation

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9
Q

Pre-Induction

  • Assess Breath Sounds
  • ____ before and after bronchodilator therapy for major elective operations (especially FEV1)
  • _______ should be >70%-80% expected or personal best prior to surgery
  • FEV1/FVC less than ____% = mod/severe asthma
  • CXR, ABG
A
  • PFTs
  • FEV1/FVC
  • 50%
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10
Q

Pre-Induction (con’t)
➢________ – good choice (anxiety can precipitate bronchospasm)
➢Opioids: consider the respiratory depressant effect
➢H-2 antagonist: _________ receptors responsible for bronchoconstriction
➢Continue current asthma ________ into peri-op period

A
  • benzodiazipines
  • unopposed H-1
  • medications
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11
Q

Peri-operative Prophylaxis of Bronchoconstriction
➢Pre-operative bronchodilators – _______ before induction
➢Pre-operative steroids
1. Inhaled – start ___ hours pre-op
2. IV - _________ 100mg Q 8 hrs on day of surgery if FEV1 less than 80% predicted or at risk for HPA suppression

A
  • albuterol
  • 48
  • hydrocortisone
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12
Q

Asthma and Anesthesia
Anesthesia-
➢Consider regional techniques
➢GA should be designed to
- depress ______ reflexes, avoid hyperactivity, avoid
bronchoconstriction, avoid _______ release

A
  • airway

* histamine

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13
Q

Induction and Maintenance in the Asthmatic Patient:
➢Blunt airway reflexes and bronchoconstriction response during airway instrumentation
- Regional Anesthesia a good option, IV induction: propofol & ______
best, avoid drug preparations with ______, IV opioids
●Consider _______ 1.5 mg/kg IV or intratracheal (LTA)

A
  • ketamine
  • metabisulfites
  • lidocaine
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14
Q

Induction and Maintenance in the Asthmatic Patient
•High concentration of volatile agent ______ for bronchodilation and bronchial reflex inhibition (need a strong CV system)
•Sevoflurane and Halothane less _______ – less coughing to trigger bronchospasm

A
  • > 1.5 MAC

* pungent

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15
Q

Induction and Maintenance in the Asthmatic Patient
➢Avoid NDMR that release ______
- _______, mivacurium, metacurium, d-tubo
➢Anticholinesterase drugs
- _______ O.K. if given with anticholinergic (glycopyrulate)

A
  • histamine
  • atracurium
  • neostigmine
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16
Q

GA for asthma, what medications are attractive and not attractive – and why?
➢Induction agents
*Thiopental – not attractive as releases ______
*Ketamine – _______ (SNS stim) but also stimulates secretions
*Etomidate, propofol – attractive -no release histamine. Generic
propofol contains _____ – consider avoiding in the asthmatic.

A
  • histamine
  • bronchodilator
  • sulfites
17
Q

GA for asthma, what medications are attractive and not attractive – and why? (con’t)
➢Neuromuscular relaxant
- Avoid those that trigger ______ release (succs, curare,
mivacurium, atracurium – dose and speed of admin dependent)
➢Opioid
- Avoid drugs that stim histamine release (morphine). Fentanyl and
analogues are OK.
➢Consider avoiding ______ & other NSAIDs in the asthmatic.

A
  • histamine

* ketorolac

18
Q

Anesthesia Plan
➢Volatile anesthetics:
- All are potent bronchodilators however _____ and ____ irritate the
airways, especially during induction and/or emergence.
- Halothane is the classic volatile agent for the asthmatic but being
replaced by ________

A
  • isoflurane & desflurane

* sevoflurane

19
Q

Induction and Maintenance in the Asthmatic Patient
➢IV fluids – liberal hydration to decrease ______ of secretions
➢Intra-op bronchospasm – attach _______ MDI to T-piece of ETT
➢Smooth emergence – ETT promotes reflex _____ and a/w resistance
➢Deep extubation (in appropriate patients) &/or lidocaine 1-3mg/kg IV

A
  • viscosity
  • albuterol
  • bronchoconstricion
20
Q

Ventilation Goals in the Asthmatic Patient
➢Decreased RR to 8-10 bpm: need adequate exhalation times
➢Prolong ___ ratio: shorter inspir time compared to expir time
➢Increase ______ to maintain normal PaCO2 (within limits)
➢Tidal volume and inspiratory flow rate adjustments limited by excessive ________ pressures (___ cmH2O upper limit)

A
  • I:E
  • TV
  • peak airway, 40
21
Q

What is in the differential diagnosis of intraoperative wheezing?
➢Foreign body (gastric tube in the lung), Partially blocked/kinked ETT
➢Light anesthesia, _______
➢_________ intubation, Pneumothorax
➢Pulmonary ______, Pulmonary edema “cardiac asthma”
➢Acute exacerbation of asthma

A
  • aspiration
  • endobronchial
  • embolus
22
Q

Bronchospasm: If an episode of bronchospasm occurs during anesth

  • Administer _____ , Deepen the level of anesthesia as with a VA or IV drugs, Administer ___ agonist
  • In severe cases administer _____ IV (severe cases; infusion 2-8 mcg/min, subcutaneously 0.3-0.5 mg q20-30 min)
  • Consider IV corticosteriods 1-2mg of cortisol
  • Consider IV ________
A
  • 100% O2
  • B2
  • epinepherine
  • aminophylline
23
Q

Avoid at all cost taking a patient to the OR who is actively __________, especially for an elective procedure!!!!!! AAHHH!!!!

A

*WHEEZING

24
Q

Asthma: Review -> Chronic disease consisting of:
●Chronic airway _________
●Airway wall _________ in severe cases- increased airway epithelium, increased sub-mucosa, and increased smooth muscle
●Reversible expiratory flow _______ (bronchial hyperactivity)
●Degree of expiratory airflow obstruction dynamic – varies over time

A
  • inflammation
  • thickening
  • obstruction
25
Q

Asthma: Alterations in PFTs/Lung Volumes (con’t)

  • During asthma attack FEV1 ______%: common
  • _____ loop show charac. downward scooping of the expir limb
A
  • less than 35%

* flow volume

Coexisting diseases (8 decks)

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