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Anesthesia 101 > Basic - Respiratory > Flashcards

Basic - Respiratory Flashcards

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1
Q

Why does smoking cause the hgb dissociation curve to shift leftward?

A

Cigarette smoke contains carbon monoxide

  • high affinity for hgb
  • Reduces 2,3 DPG
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2
Q

_____ blocks commonly cause ipsilateral phrenic n block, but is not associated with significant reduction in FRC if pt has otherwise normal pulmonary function

A

Interscalene block

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3
Q

*FRC is = to ?

A

ERV + RV
or
TLC - (IRV + TV)

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4
Q

what is closing capacity?

A

The volume in the lungs during expiration when the alveoli BEGIN to close

RV (residual volume) + CV (closing volume)

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5
Q

Why is FRC reduced in morbidly obese pts?

A

d/t decrease in ERV

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6
Q

During forced exhalation, which part of the lung is emptied first? Airway closure occurs where first?

A

Lung apices - emptied first

Lung bases - closes first

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7
Q

Lung resistance comprises of what 2 things?

A

Airway resistance
and
Elastic resistance

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8
Q

______ resistance affects airflow into the lungs.

- Peak inspiratory pressure (PIP) directly varies with flow resistance.

A

Airway resistance

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9
Q

______ measures resistance from the ventilator tubing to the segmental bronchi.

A

Peak inspiratory pressure (PIP)

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10
Q

______ resistance affects expansion of the lungs. Can be thought of as pulmonary compliance
- can affect both Peak inspiratory pressure (PIP) and plateau pressure (Pplateau)

A

Elastic resistance

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11
Q

Situations that increase airway resistance will increase _____ on the ventilator. Examples include ___

A

Peak inspiratory pressure (PIP)

  • bronchospasm
  • kinked ETT
  • mucus plug
  • airway secretions

*Pplateau unchanged

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12
Q

Situations that increase elastic resistance (or decrease compliance) will increase _____ on the ventilator. Examples include ___

A

PIP and Pplateau

  • PTX
  • PNA
  • Pulm edema
  • Abdominal insufflation
  • Tburg
  • Obesity
  • ILD
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13
Q

When does the greatest decrease in FRC occur?

A

Going from 60 degrees to totally supine 0 degrees

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14
Q

(True/False) there is a significant decrease in FRC when changing from zero degrees to Tburg up to -30 degrees

A

False

unless you’re going past -30 degrees, theres no sig drop in FRC

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15
Q

FRC is directly proportional to ____, and is reduced by __% in females.

A

height

10%

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16
Q

How does positioning affect closing capacity?

A

it doesnt.

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17
Q

Factors that affect closing capacity

A
  1. COPD
  2. CHF
  3. Smoking
  4. Ongoing Surgery
  5. Age

*all alter transpulmonary pressure across airways, resulting in easier airway collapse at higher lung volume

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18
Q

Pressure vs Volume control

  • Triangle wave
  • Square wave
A
  • Triangle wave: volume control

- Square wave: pressure control

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19
Q

What is the mechanism behind auto-PEEP or intrinsic PEEP?

A

the Alveolar pressure remains positive at end-expiration

  • Lungs are unable to empty at end of exhalation and next breath starts
  • worsens gas exchange
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20
Q

Why are COPD pts at increased risk for breath stacking?

A

Loss of elements that keep the lungs open during expiration

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21
Q

After smoking cessation, how long is mucocilliary function worsened?

A

2 weeks

- inc sputum production

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22
Q

deadspace vs intrapulmonary shunt

  • what is it?
  • which one is compromised in tburg?
A

deadspace: ventilation w/o perfusion

intrapulmonary shunt: perfusion w/o ventilation

*shunt is increased in t burg, no effect on deadspace

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23
Q

central sleep apnea vs obstructive sleep apnea?

A

CSA:

  • brain respiratory centers do no function properly during sleep
  • Fail to trigger inhalation
  • apnea > 10s, >10x/hour

OSA:

  • brain fxn fine
  • snoring common
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24
Q

Overtime, why do pts with OSA develop CSA (mixed sleep apnea)?

A

d/t heart failure caused by OSA

- Hypoxia/hypercapnea -> pulm HTN -> RVH -> RVF

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25
Q

Pulmonary vascular resistance increases at (high/low) lung volumes. Why?

A

Both

PVR increases at low lung volumes d/t:

  • as alveoli size decrease (and collapse), the geometry of pulmonary vessels surrounding alveoli bcome kinks -> resistance to flow
  • as lung volume decrease below nl, volume of blood in the larger pulmonary vessels dec. -> dec vessel radius -> inc resistance to flow
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26
Q

Tense abdominal ascites causes a (restrictive/obstructive) lung disease pattern

A

Restrictive

- FEV1/FVC: normal (both are reduced)

27
Q

what is vital capacity?

A

The maximal amt of air that can fill the lungs and participate in gas exchange

28
Q

In restrictive lung disease, what spirometric patterns are decreased?

A 
Forced vital capacity (FVC)
- amt of gas that can be forcefully and maximally exhaled from a maximal inhaled vol
FEV1
FRC
TLC

*- proportional decrease in all lung volumes

29
Q

Pts with (obstructive/restrictive) lung diseases present with low FEV1/FVC

A

Obstructive

  • Decreased FEV1: airway collapse with forced exhalation
  • FVC: inc or unchanged
30
Q

In restrictive lung disease, what happens to FEV1/FVC?

A

Normal

- proportional decrease in all lung volumes

31
Q

Bronchospasm is (smooth/skeletal) muscle mediated

A

smooth muscle

- Skeletal muscle relaxants have no effect

32
Q

Ways to manage bronchospasm preoperatively

A
  1. Pretreat with corticosteroids days prior
  2. Topical lidocaine
  3. Albuterol
33
Q

For respiratory acidosis, the pH will decrease by ___ for every acute _____ increase in PaCO2.

A

0.05

10mmHg

34
Q

in respiratory acidosis, Bicarbonate will increase ___ and ____ for every 10 mmHg acute and chronic increase in PaCO2

*shortcut fashion

A

acute: 1 mEq/L
chronic: 4-5 mEq/L

35
Q

Most common cause of shunt in perioperative period?

A

Atelectasis

36
Q

Pulmonary shunt is (increased/decreased) by increasing oxygen concentrations

A

Increased

- leads to blunting of hypoxic pulmonary vasoconstriction and microatelectasis

37
Q

Which is always higher, PaCO2 or ETCO2?

A

PaCO2

  • spontaneously breathing: 2-5 mmHg higher
  • ventilated: 5-10mmHg higher
38
Q

What contributes to the difference btwn PaCO2 and ETCO2?

A

dead space ventilation

  • decreased cardiac output causing decreased lung perfusion
  • decreased lung perfusion
  • inc in regional lung ventilation
  • cardiogenic shock
  • PE
  • overinflation during PPV
  • High PEEP
  • R->L intracardiac shunt
  • Esophageal intubation
39
Q

The lung receive innervation from the sympathetic system via ___.

A

T2-T7

Parasympathetic system via vagal efferent and afferent nerves

40
Q

ABG of pt w/ severe CO poisoning?

A

Metabolic acidosis

  • nl PaO2
  • Falsely elevated SaO2
41
Q

How does Deadspace change with positioning? Neck positioning?

A

Upright: increase
- apex of lungs are essentially non-perfused d/t gravity
Supine: decrease

Extension: increase
Flexion: decrease

  • deadspace: ventilation w/o perfusion
  • portion of lung not involved in perfusion (therefore, not involved in gas exchange)
42
Q

Common causes of increased deadspace (5)

A
  1. Anticholinergics
  2. Bronchodilators
  3. Increase pulmonary vascular resistance (emphysema and COPD)
  4. Positioning (supine, neck extension)
  5. Decreased Cardiac output
43
Q

In ACUTE respiratory acidosis, Bicarbonate will increase ____ for every 1 mmHg increase in PaCO2 above 40 mmHg and increase ____ for every 10 mmHg increase in PaCO2

A

0.2 mmol/L

2 mmol/L

44
Q

In CHRONIC respiratory acidosis, Bicarbonate will increase ____ for every 1 mmHg increase in PaCO2 above 40 mmHg, and increase ____ for every 10 mmHg increase in PaCO2

A

0.4 mmol/L

4 mmol/L

45
Q

Arterial oxygen content (CaO2) equation

A

CaO2 = (Hgb * 1.36 * SaO2) + (0.003 * PaO2)

SaO2 = % hgb saturated with O2, nl = 95%

46
Q

Commonly observed capnography in pts with COPD who received single lung transplant

A

Double Peak

  • Difference btwn healthy transplanted lung, and diseased native lung
  • First peak: rapid exhalation of healthy, transplanted lung
  • Second peak: slower rate of rise of exhaled CO2 from diseased, obstructed lung
47
Q

Trace nl capnogram in your head

A

Phase 1-2:
- Beginning of expiration

Phase 2-3:
- Early expiration

Phase 3-4:

  • expiratory alveolar plateau
  • continued exhalation of CO2 from lung alveoli

Phase 4-1: sharp downstroke
- inspiration

48
Q

For respiratory alkalosis, for every 10mmHg decrease in PCO2, HCO3- decreases by ___ (acute), or ___ (chronic)

A

2

4

49
Q

For respiratory acidosis, for every 10mmHg increase in PCO2, HCO3- increases by ___ (acute), or ___ (chronic)

A

1

4

50
Q

Impairment of airflow during the EXPIRATORY phase is a result of a variable ______ airway obstruction or ____

A

INTRAthoracic

  • distal tracheal tumor
  • mediastinal mass
  • below vocal cords

COPD

51
Q

Impairment of airflow during the INHALATIONAL phase is a result of a variable ______ airway obstruction

A

EXTRAthoracic

  • above vocal cords
  • vocal cord paralysis
  • glottic stricture
  • proximal t
52
Q

in pts having acute bronchospasm under GA, first line medical treatment:

A

beta agonist

- albuterol

53
Q

Why are infants prone to bradycardia during laryngoscopy and intubation?

A

d/t predominance of parasympathetic nervous system

54
Q

What does intubation with PEEP do to CVP, PAP, CI, and PCWP?

A

Increase CVP, PAP, and CI

Decrease PCWP (indirect estimate of LAP)

  • increasing RV afterload
  • decreasing LV afterload
55
Q

Obese individuals have decreased FRC (ERV + RV), which is reduced most?

A

ERV
- leading to decrease in lung compliance, airway closure, and decreased PaO2

*RV is preserved

56
Q

Why is morphine and atracurium not the safest choice in pts with asthma?

A

associated with histamine release -> induces bronchospasm

57
Q

Treatment for bronchospasm if you can ventilate? What if you cant?

A

Can: Deepen anesthetic, inhaled B2 agonist, inhaled anticholinergics

Cant: IV epi, subQ terbutaline

  • Mast cell stabilizer
  • strong B2-agonist activity
58
Q

Summary of Respiratory system changes with aging: (6)

A
  1. Decreased vital capacity
  2. Increased residual volume
  3. Increased closing capacity
  4. Increased anatomic dead space
  5. Increased lung compliance
  6. Increased pulmonary vascular resistance
59
Q

Why does hyperventilation lower extracellular K levels?

A

Hyperventilation -> lower plasma CO2 levels -> L shift in bicarb buffer system -> lowers H+ [ ] -> K+ shifts intracellularly to maintain electrical neutrality

60
Q

How does Na affect MAC requirements?

A

Hypernatremia increases MAC req

Hyponatremia decreases MAC req

61
Q

Oxygenation is solely dependent on _____ during apnea

A

FRC

62
Q

Oxygen consumption in an adult is ____ mL/kg

FRC in adult _____

A

3-4 mL/kg/min (adults)
7-8 (kids)

30 mL/kg

63
Q

FGF must be equal to _______ to prevent rebreathing in the Mapelson A circuit.

FGF must be equal to _______ to prevent rebreathing in the Mapelson D,E,F circuit.

A

minute ventilation

2-3x minute ventilation

Anesthesia 101 (38 decks)

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