Case 13 - Thoracosopy Flashcards
1
Q
patient is undergoing VATs. You are trying to decide between DLT and bronchial blocker. What are the disadvantages of bronchial blocker?
A
Disadvant of bronchial blocker
- difficult to place
- higher chance of dislodging
- smaller lumen results in delayed lung deflation
2
Q
You are now on one lung ventilation. Patient begins to experience a decrease in SaO2. What can you do to treat this?
A
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
3
Q
what are complicatoins of VATs?
A
- arrythmias
- Sinus tachy
- Afib
- SVT
- resp failure
- bleeding
- infection
- aire leak
- chronic pain
