Final Exam Flashcards
Is endovascular repair of vessel disease generally associated with less blood loss and shorter recovery times?
Yes. EV surgery is a minimally invasive surgery that was designed to access many regions of the body via major blood vessels. As catheter is introduced a radio opaque dye can be seen on X-ray or fluoroscopy allowing visualization of atherosclerosis, vascular trauma, or aneurysms. Advantages: shorter recovery period, less discomfort, local or regional anesthesia vs general, smaller incisions, less stress on heart, and fewer risks.
Name some indications for one-lung ventilation:
Empyema, lung resection, multiple lung biopsies with sclerosing, large cyst or bulla, esophageal surgery, single lung transplant. NOT medianstinoscopy, which is a procedure the enables visualization of the contents of the mediastinum… Usually to obtain a biopsy… This is often used for staging lymph nodes of lung cancer… An incision is made approx 1cm above the suprasternal notch of the sternum (breast bone)…. Dissection down to pretracheal space and down to carina…scope is advanced into created tunnel which provides view of the mediastinum.
After placing a left double lumen tube you inflate and hear breath sounds only on the left. What is the problem?
More than likely the tube is too far in the left bronchus.
If you have a patient upright and convert from spontaneous ventilation to positive pressure ventilation, gas flow is increased to the (APEXES OR BASES)
Apexes
The lung that has a bronchus branch closest to the carina is the ______ lung.
Right
In the lungs, blood flows preferentially to (DEPENDENT OR NONDEPENDENT) areas?
dependant
A patient receiving positive pressure ventilation in the left lateral position will have greatest gas flow and greatest blood flow to which areas?
greatest gas flow to the right lung; greatest blood flow to the left lung
The zone that is best for optimal respiration is _____________.
Zone 3
The most detrimental scenario that affects V\Q mismatching is:
Mechanically ventilated patient, VAA general anesthesia, and muscle paralysis; (Any spontaneous breathing is better than mechanically ventilated)
Internal intercostal muscles aid in which part of breathing?
expiration
Is pneumothorax control an indication for lung isolation?
NO; unilateral, broncho-pleural fistula, lung resection are examples of indications for lung isolation
What are treatment techniques for hypoxia during one lung ventilation with double lumen tube?
insufflation of O2 into the non-ventilated lung, CPAP to the non-ventilated lung, re-inflate non-ventilated lung; NEVER INCREASE TV HIGHER THAN WHAT WAS ADEQUATE FOR BOTH LUNG VENTILATION
What responses to non-depolarizing muscle relaxants might be seen in a patient during a thymectomy for treatment of myasthenia gravis?
prolonged blockade, heightened sensitivity, exaggerated response; NOT A RESISTANCE TO PARALYSIS
What are some characteristics of upright spontaneous ventilation?
end expiration alveolar volume greatest in apex alveoli, blood flow best to the bases, alveolar ventilation closely matched to blood flow; NOT GREATEST ALVEOLAR VENTILATION IN APEXES!!
What is considered a functional respiratory unit of the lung?
alveoli
How do you verify proper placement of a left double lumen tube?
fiber optic visualization of blue bronchial cuff in left bronchus
What are some concerns associated with tracheal resection surgery for tracheal stenosis?
difficult intubation, surgical drainage into lung fields, tracheal edema; NOT TRIGEMINAL NERVE INJURY
What are some risks associated with medianstinoscopy?
hemorrhage, tracheal collapse, right innominate artery occlusion; NOT DIAPHRAGM RUPTURE
What is the standard size of double lumen tube for a 70kg 70” male patient?
37-39 French
If you clamp the tracheal lumen on a properly placed left double lumen tube, what side will the breath sounds end on?
left side
If you clamp the bronchial lumen on a properly placed right double lumen tube, what side will the breath sounds end on?
left side
When performing thorax surgery, what are some possible risks of injury?
phrenic nerve, pleural cavity, recurrent laryngeal nerve; ATA
What is the mechanism of decreased PaO2 during one lung ventilation?
right to left shunt
If you have a patient with DLT for lung resection on 800cc TV, rate of 8, I:E 1:3 and when you clamp the bronchial lumen, PIP goes from 20 to 40 and TV decreases to 500cc…. What should you do?
Change I:E to 1:1
During a medianstinoscopy to r\o lymph node involvement, the right a-line shows dampened waveform 40/10, but left hand pulse ox stays at 98% on 30% FiO2. What is the cause?
innominate artery compression
IF surgeon complains left lung is still ventilating after clamping the tracheal lumen of left DLT, what is cause?
wrong lumen clamped
What are some complications of lung isolation?
tissue trauma, malposition of DLT, hypoxemia; NOT LIGHTENING OF ANESTHETIC DEPTH
What is the cause of the greatest derangement of V/Q matching?
converting a spontaneously breathing patient to positive pressure ventilation
What is the representation of Zone I alveoli?
pA>pa>pv
Patient is in post-op after endoscopy under sedation. He is on 4L NC and pulse ox is 97%, RR 14; VSS. What is occurring?
V/Q mismatch secondary to hypoventilation
What is the average length of the trachea?
10-13cm
What is zones of West… and why the hell do we care?
deals with pressures inside the lung; Zone 1 is PA>Pa>PV (alveolar pressure is greater than both arterial and venous pressure…. resulting in obstruction of blood flow and creation of alveolar dead space; fairly small in spontaneously breathing person, but can increase with PP ventilation); Lower areas of the lung…. alveolar pressure increases d\t lower elevation above the heart; Zone 2 Pa>PA.PV…resulting in blood flow that is dependent on the differential between Pa and PA; The bulk of the lung is described as zone 3= Pa>PV>PA… results in blood flow independent of alveolar pressure; Zone 4 is the most dependent part of the lung… where atelectasis and pulmonary edema occur… blood flow dependent on differential between Pa and pulmonary interstitial pressure.
What are lung characteristics found in an upright spontaneously breathing patient?
end expiration alveolar volume greatest in apex alvoli; blood flow best in bases; alveolar ventilation closely matched to blood flow
What anesthetic factors block hypoxic pulmonary vasoconstriction?
volatile anesthetics above 1 MAC and vasodilators
What part of the airway is turbulent flow most likely to occur?
upper airways
What is the common cause of paraplegia with thoracic aorta surgeries?
spinal cord ischemia
What is the name of the artery associated with the paraplegia risk in descending aorta surgery repair that arises d\t the lower thoracic and lumbar injury of this artery?
artery of Adamkowitz
What happens to SVR when you clamp the distal aorta?
IT RISES!!!!!!
Can a single lumen ETT be used in VATS?
NO! you must use a DLT for lung isolation
What is the difference in a true and false aneurysm?
true aneurysm involves all 3 layers of the arterial wall (intima, media, adventitia); a false aneurysm is a collection of blood leaking completely out of an artery or vein, but confined next to the vessel by surrounding tissue; in general aneurysms >4-5cm require surgical intervention
Are vascular surgery patients at greater risk for intra-op MI d\t coexisting diseases?
No
What pt would have the least systemic vascular resistance changes: supra renal aneurysm, juxta renal, pararenal, or infra renal?
infra renal
What is the greatest risk with thoracic aneurysms > 6cm?
rupture and death
What is a frequent occurrence following the removal of an abdominal aortic aneurysm cross clamp?
acidosis
Are lower body bair huggers an absolute requirement for lengthy open thoraco-abdominal aneurysm repairs?
NO
What co-morbidity factors have the greatest risk of primary and assisted patency failure and limb loss?
CHF, TASC C/D lesions
What is the name of the conversion of electrical to mechanical energy?
Peizoelectric effect
What are some factors that indicate a post-op myasthenia gravis patient may have trouble extubating after surgery?
duration of MG >6 years, coexisting COPD, anticholinesterase dose >750mg/day
What are some risks of open thorax surgery?
1 is dysrhythmias, DVT/PE/AMI, bronchopleural fistula, chylothorax, sub-q emphysema, phrenic nerve injury, recurrent laryngeal nerve injury
What are some anesthetic complications with open thoracic surgery?
opening chest produces pneumothorax, manipulation of lung and heart and major vessels may interfere with ventilatory exchange and cardiovascular stability intra-op and post-op, lateral decubitus position changes the distribution of blood flow and pattern of ventilation and exposes lower lung to danger of contamination by secretions, blood, or fluids
What is the normal O2 consumption?
250ml/min
