Exam 4 obstructive Flashcards
What diagnosis obstructive sleep apnea?
Polysomnography recording
What does it look at?
Apnea, hypopnea, respiratory effort-related arousal
What kind of reduction of air flow is considered apnea?
90%
What is an obstructive apnea event?
Breathing effort during apnea
What is a central apnea event?
No breathing effort during apnea
How long does an apnea event have to last to be counted?
10sec
What is the AHI?
The number of apnea & hypopnea events in an hour
An AHI >15 means what?
Pt has OSA
What are the criteria for OSAS?
- AHI >5
- daytime somnolence > 2wks
What does one have to be very aware of when inducing a Pt with an AHI >30?
Pt’s sats can drop from 100% to 30% quick on induction. Be very aware with these Pt’s
What are some metabolic consequences of OSA?
- Systemic inflammation
- ↑SNS activity
- hormonal changes
- insulin resistance
- metabolic syndrome
What are the most common sites for airway narrowing?
Retropalatal and retroglossal regions of the oropharynx
What kind of obstruction will be seen a lot?
Excess soft tissue/tonsils
What is functional collapse?
Forces that can collapse the upper airway > the forces that dilate the upper airway
What increases airway obstruction while supine?
Increases the effect of extraluminal positive pressure against the pharynx
What stimulates the arousal response?
Hypercapnia, hypoxia, upper airway obstruction & work of breathing
What are the day S/S of sleep apnea?
- Dry mouth or headache upon waking
- sleepiness
- falling asleep during monotonous situations
- subjective impairment of cognitive function
What are the night S/S of sleep apnea?
- Frequent awakening
- awaking from own snoring w/ choking sensation
- loud snoring
- observed pauses in breathing during sleep
- tachycardia
- non-restorative sleep
What are the risk factors for OSA?
Age, obesity, minorities, male, pregnancy, smoking
What surgery is recommended for OSA?
Maxillomandibular advancement (MMA)
What does the electrical stimulation surgery do for someone with OSA?
It stimulates hypoglossal nerve → contracts to keep airway open. (Very expensive)
A Mallampati score of 2 results in what odds for OSA?
A 5 point increase for odds of Pt having OSA
What does STOP-Bang stand for & what does it check?
A scale to show risk for OSA (Pts that have not been diagnosed for OSA)
Snore, Tired, Observed, Pressure, BMI >35, Age >50, Neck >17”, Gender (male)
What anesthetic considerations are there for a Pt with OSA?
- Less is more
- Elevate HOB
- Pre-oxygenate
- Possible difficult intubation
- Use minimal to no opioids
- Regional is better than GA
What are the S/S for an URI?
- Nonproductive cough
- sneezing
- rhinorrhea
How long is elective Sx delayed for a current URI?
6wks
When do you proceed with Sx in someone that has a URI?
If S/S are getting better → proceed w/ sx
What equipment is preferred for someone with an URI?
- An LMA > ETT
- If using ETT use lidocaine & suppress SNS airway stimulation or nebulizer with lidocaine in pre-op
What are possible adverse induction events for someone with an URI?
- Bronchospasm
- laryngospasm
- airway obstruction
- postintubation croup
- desaturation
- atelectasis
What stimuli provoke asthma?
Allergens, ASA, NSAIDs, beta-antagonist, infections, exercise, stress, endorphins & vagal mediation
Where specifically is the airway edema in asthma?
In the bronchi
What inflammatory mediators are released in asthma?
- Histamine
- prostaglandin D2
- leukotrienes
How is asthma diagnosed?
Airflow obstruction on pulmonary function testing that is at least partially reversible with bronchodilators
What are the usual PFT results in someone with asthma?
- FEV1 < 35% of normal
- FRC - may increase substantially
- TLC - within normal range
What PaO₂ indicates severe asthma?
PaO₂ <60 mm Hg on room air
When is an asthmatic Pt stress dosed?
If been on IV or PO steroids for while then give stress dose
What are the 2 meds that have long-acting bronchodilator & steroid combo?
- (Symbicort) Budesonide + formoterol
- (Advair) Fluticasone + salmeterol
What induction drugs are best for asthma Pt’s?
- Lidocaine, propofol or ketamine
- Avoid histamine-releasing NMBDs
What are the risk factors for COPD?
Pollution, recurrent childhood resp infections, low birth weight, asthma, age, female, poor lung development, lower socioeconomics
What are the S/S for COPD?
- Dyspnea on exertion or at rest, chronic cough, and chronic sputum production
- Exacerbations… acute worsening airflow obstruction
- Tachypnea and prolonged expiratory time
- Decreased breath sounds, expiratory wheezes
When does a COPD’er get long-term O2 therapy?
PaO2 <55 mmHg, Hct >55% or cor pulmonale
What is the PaO2 goal for a COPD’er?
> 60 mmHg
What would we want a COPD’er albumin level to be?
At least 3.5 mg/dL (lower albumin = increased pulm risks)
Which abnormal ABG labs would lead to an Pulmonology consult?
- Bicarbonate > 33 mEq/L
- PCO2 > 50 mm Hg
What VA agent is best suited for a COPD’er?
Sevoflurane
What VA agent should be avoided with COPD’ers?
Nitrous oxide
What is the minimum time a smoker should stop smoking before elective surgery?
Minimum 6 weeks
What is the elimination half-life of carbon monoxide?
approximately 4–6 hours
