Case 13 - Thoracosopy

Question 1

patient is undergoing VATs. You are trying to decide between DLT and bronchial blocker. What are the disadvantages of bronchial blocker?

Answer 1

Disadvant of bronchial blocker

• difficult to place
• higher chance of dislodging
• smaller lumen results in delayed lung deflation

Question 2

You are now on one lung ventilation. Patient begins to experience a decrease in SaO2. What can you do to treat this?

Answer 2

Tx of Hypoxia during OLV

1) Notify Surgeon
2) FiO2 100%
* start at 100%, reduce as necessary to maintain SaO2
3) Check Insp Pressure and BP
* listen for BS; Rule Out Pneumo and bronchospasm
4) recruitment maneuavers + PEEP 5-10 cm H2O

• helps return FRC to normal (prevent atelectasis)
• too much PEEP = bad -> will increase dependent lung PVR and divert flow away from good lung

5) Search causes of hypoxemia (machine to patient)

• kinking of circuit or DLT
• secretions
• DLT malposition
• pneumothorax or bronchospasm
• low CO (sepsis, anaphyl, PE, acute MI with CHF)
• hypoventilation (hypercarbia; A-a equation)

6) Add CPAP 5-10 cm H2O to nondendent lung

• open alveoli -> participate in gas exchange with blood flow that flows into non-depn lung
• Cannot do in VATs cases

7) clamp nondependent pulmonary Artery if accessable during sx
8) accept lower SaO2

Question 3

what are complicatoins of VATs?

Answer 3

• arrythmias
  
  • Sinus tachy
  • Afib
  • SVT
• resp failure
• bleeding
• infection
• aire leak
• chronic pain