Fiberoptic And One Lung Ventilation Flashcards
Absolute Contraindications for Fiberoptic
Lack of time
Relative contraindications for Oral Fiberoptic
Edema of pharynx or tongue Infection Hematoma Infiltrating masses Presence of pharyngeal abcess
Relative Contraindication for Nasal Fiberoptic
Patients with platelet abnormalities or coagulation disorders
If pregnant or have heart disease (can’t use vasoconstrictors)
Fiberoptic drug of choice to reduce secretions
Anticholinergics
Rigid Fiberoptics
Wooscope McGrafth Bullard Glidescope Upsher
Pre-op testing for one lung
Spirometry (FEV1)
Diffusing capacity of lung for carbon monoxide (DLCO)
Exercise study
Right main bronchus diverges from trachea at angle of __ and left main bronchus diverges at an angle of ___.
25 degrees, 45 degrees
Double lumen tubes:
35 - 37 for women, 39, 41 for men
Average depth of double lumen:
29 cm for pts 170 cm tall ( plus of minus a cm every 10 cm change in height)
How do you visually confirm placement of left sided tube?
- Visualization of carina
- Non-obstructed view of right main bronchus
- Tube entering left main stem
- Blue bronchial cuff below carina
Why you use a bronchial blocker?
If patient need to remain ventilated and not have to change out to single lumen tube.
The intrapulmonary distribution of blood flow is regulated by:
Gravity, lung volume and regional vascular resistance
Nondependent vs dependent lung
Non-dependent lung is poorly perfused but well ventilated. Dependent lung is well perfused but poorly ventilated.
Management of one lung ventilation
- FiO2 close to 1
- Multiple ABGs
- Adjust respiratory frequency
- Reconfirm proper position
- 5 -10 cm H2O of peep to dependent lung
- CPAP of 5 - 10 cm of CPAP to nondependent lung
- Occlude pulmonary artery
- Resume 2 lung ventilation if all else fails
Post-op Pulmonary Complications
- Atelectasis
- Hypoxemia
- Hypoventilation
