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A1 > CV thoracic > Flashcards

CV thoracic Flashcards

1
Q

What is the leading cause of cancer deaths in the US?

A

Lung cancer- 4x higher in COPD patients

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2
Q

Respiratory patients require what type of assessment before surgery?

A

PFT and cardiac testing

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3
Q

Predictors of PPC

A

FEV1 <2L OR <40% of predicted
DLCO <40% predicted
VO2 max <10 ml/kg/min
Inability to climb 1 flight
Oxygen desat >4% during exercise

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4
Q

Risk factors for respiratory disease

A

Smoking
Air pollution
Chemical exposure
Co existing ischemic cardiac disease

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5
Q

How long must surgery be delayed if they are high risk cardiac disease?

A

6 weeks before CABG

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6
Q

What is pancoast syndrome?

A

Superior pulmonary sulcus tumor which may involve the brachial pllexus
Ipsilateral shoulder/ arm pain/ atrophy
Horners syndrome (ptosis, miosis, anhydrosis)

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7
Q

Lambert Eaton syndrome

A

Weakness and sensitivity to NMBs

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8
Q

What is carcinoid syndrome

A

Flushing, hotn, tachyarrhythmias related to serotonin
Caused by histamine releasing drugs

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9
Q

Bleomycin, doxurubicin, cisplatin

A

Bleo- pulmonary toxicity
Doxurubicin- cardiac toxicity
Cisplatin- renal toxicity

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10
Q

Most common lab finding in PPC

A

Albumin <3.6
But also of note: Paco2 >45 not independent PPC risk factor) , BUN >22

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11
Q

A ___% increase in FEV1 post bronchodilator treatment is considered significant

A

12%

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12
Q

How would you assess parenchymal function?

A

DLCO

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13
Q

How would you assess cardiopulmonary reserve?

A

VO2 max

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14
Q

Smoking cessation prior to surgery is recommended for ____

A

4 weeks

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15
Q

What position for thoracotomy?

A

Lateral decubitus with roll caudal to the axilla

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16
Q

Where is V / Q highest in the awake lateral position?

A

Both in dependent lung
Gas exchange remains efficient

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17
Q

Where is V / Q highest in the anesthetized spontaneous lateral position?

A

FRC drops mildly
V- nondependent
Q- dependent
VQ- mismatch

18
Q

Where is V / Q highest in the anesthetized mechanically ventilated lateral position?

A

FRC drops low
VQ mm intensifies, but can be minimized with PEEP

19
Q

Where is V / Q highest in the anesthetized mechanically ventilated open chest lateral position?

A

Worst VQ mm

20
Q

Absolute indications for OLV

A

Isolation of contamination
Avoid hemorrhage spillage
Giant cyst or bulla, bronchopleural fistula, surgical opening at airway, unilateral lung disease

21
Q

DLT cant be used on ___

A

small children

22
Q

DLT sizes

A

Based upon height
Females- 35, 37 (over/ under 160cm)
Males- 37, 39 (under 175cm), 41, 43 (over 175cm)

23
Q

Most common complication of DLT

A

Malposition
But also note: rupture thoracic anuerysm, damage vocal cords, bronchial rupture, barotrauma if too deep into a single lobe

23
Q

Distance for DLT

A

Female- 27
Male- 29
STOP if resistance though

24
Q

DLT cuffs

A

tracheal- 10
bronchial- 1-2

25
Q

How to verify placement of DLT?

A

flexible bronchoscopy

26
Q

Pros and cons of bronchial blockers

A

Pro- less insertion complication, better if already intubated, can be used on peds
Cons- takes more time, required a fiberoptic, greater incidence of malposition, no suction

27
Q

What can inhibit HPV?

A

Vasodilators
PEEP, hypocapnia, volatile anesthetics >1.5 MAC, alkalosis, n2o increases PVR

28
Q

What is safe for HPV?

A

Volatile <1.5MAC
TIVA
Epidural t6-t8

29
Q

Vent management on OLV

A

6ml/kg (low)
PEEP with low Vt
PIP <25
Hypercapnia
fio2 <1.0

30
Q

Causes of hypoxemia during OLV

A

Most appropriate to check first- Tube malposition
Bronchospasm, decreased CO, Hypoventilation, low fio2, ptx to dependent lung

31
Q

Management of hypoxemia during OLV

A

CPAP to non dependent/ non ventilated lung
PEEP to dependent lung
Resume 2 lung ventilation7tmjjmm,,,mt

32
Q

Anesthetic management of mediastinoscopy

A

Watch for brady- with glycco ready to give
large bore iv
type and cross available
Watch for hmrg, ptx, bronchospasm, vae

33
Q

Indication for VATS

A

ID disease
Tumor biosy
Stage cancer
Bullous COPD

34
Q

High risk patients for thoracotomy

A

Pulmonary fibrosis
>80
FEV1 <.4 predicted
DLCO <.4 predicted
ASA 4
surgery >80 minutes

35
Q

Most common complicaitons after thoracotomy

A

Respiratory failure
Cardiac dysrhythmias
ALI

36
Q

Significant factors associated with ALI (what can cause it)

A

Right pneumonectomy
Intraoperative overhydration
Preoperative alcohol abuse
High introperative airway pressures

37
Q

Risk factors for ALI

A

Female
Trauma
Infection
PPC risk factors
Chemo
OLV >100 minutes
Transfusion in OR
O2 toxicity

38
Q

Chest tube drainage > ____ requires intervention

A

200

39
Q

What nerves can be damaged following thoracotomy

A

Phrenic
RLN
Spinal cord/ radicular artery

40
Q

Anesthetic plan for mediastinal mass biopsy

A

LA

41
Q
A

A1 (124 decks)

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