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Anesthesia based on Nebuchanedzzer II > ITE Pulm > Flashcards

ITE Pulm Flashcards

1
Q

Cormack-Lehane system

- Grade 1

A

Complete glottis visible

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2
Q

Cormack-Lehane system

- Grade 2b

A

Anterior glottis not visible.

Only posterior arytenoids and epiglottis visible.

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3
Q

Cormack-Lehane system

- Grade 3

A

Epiglottis, but not glottis is visible

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4
Q

Cormack-Lehane system

- Grade 4

A

Epiglottis is not visible

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5
Q

First line treatment for asthma exacerbation in OR

  • bronchospasm
  • airway inflammation
  • mucous plugging
A

100% FIO2
then deepen the anesthetic

*Beta agonists can worsen oxygenation d/t changes in V/P mismatch

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6
Q

Inhaled corticosteroids for asthma treatment take ____ (time) to see significant changes

A

6-12 hours

- treat inflammatory component

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7
Q

Heliox is a ____ andis a useful adjunct in that it helps to decrease the density of delivered gases (ie: Beta2 agonists and steroids get past obstruction), resulting in less pt effort needed to get the same volume of gas.

A

mixture of 70% helium and 30% oxygen

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8
Q

How does giving a beta-2-agonist in pts having a bronchospasm worsen the oxygenation?

A

d/t changes in V/P mismatch

  • The under-ventilated alveoli will have concomitent pulmonary vasoconstriction to decrease the amount of shunting
  • When B2-agonist is used, some bronchodilation occurs, but inflammation and mucous plugging continues
  • there is increased perfusion to poorly ventilated lung units -> V/Q mismatch
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9
Q

Bronchospasm affects ____ muscle, and nondepolarizing relaxants affect ____ muscle

A

smooth

skeletal

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10
Q

________ block occurs in 100% of patients undergoing interscalene blockade, even with dilute solns of local anesthetics and results in a ___% reduction in pulmonary function

A

Ipsilateral phrenic nerve block

- results in diaphragmatic paresis

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11
Q

Most common level for placement of interscalene block

A

Between Anterior and middle scalene m

  • at the cricoid cartilage or C6 vertebrae lvl
  • Where the cervical n roots C5-6 leave the spine
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12
Q

The interscalene block may spare the ____ nerve.

A

ulnar nerve.

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13
Q

Intraarterial injection of local anesthetics would cause what type of symptoms?

A

CNS symptoms

immediate sz

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14
Q

intrathecal injection of massive amts of local anesthetics would cause what type of symptoms?

A

total spine
LOC +
respiratory insufficiency/apnea

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15
Q

Foreign body in children display signs of ______, while adults often display signs of ______

A

Children
- air trapping: hyperinflation with obstructive emphysema

Adults
- atelectasis

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16
Q

Two most feared complications of mediastinal mass in anesthesia

A
  1. Complete airway obstruction w/ inability to maintain gas exchange
  2. Cardiovascular collapse from compression of vital structures.
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17
Q

GA approaches to pts with mediastinal mass

A
  1. local/regional anesthesia whenever possible
  2. Awake intubation.
    - Secure airway beyond lesion.
    - Confirm ability to ventilate and oxygenate
    - Have thoracic surgeon in room during induction
    - Ensure availability of rigid bronchoscopy if obstruction occurs
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18
Q

______ results in a flow-volume loop with an:

  • expiratory phase with a quick peek followed by a much lower than normal plateau phase. *kink
  • normal inspiratory phase
  • Graph shifts to L
A

COPD

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19
Q

Assuming full inspiratory and expiratory efforts are made, end INSPIRATION volume is equal to ______, and end EXPIRATION is equal to ____

A

total lung capacity

residual volume

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20
Q

Examples of intrathoracic airway obstruction and extrathoracic airway obstruction

A

intrathoracic airway obstruction

  • distal tracheal tumor
  • mediastinal mass

extrathoracic airway obstruction

  • vocal cord paralysis/dysfunction
  • proximal tracheal tumor
  • glottic strictures
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21
Q

What causes a flow-volume loop with plateaued AND decreased inspiratory and expiratory flows?

A

Fixed upper airway obstruction or fixed large airway obstruction?

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22
Q

A variable INTRATHORACIC airway obstruction produces a flow-volume loop with a plateaued (inspiratory/expiratory) curve.

A

expiratory

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23
Q

A variable EXTRATHORACIC airway obstruction produces a flow-volume loop with a plateaued (inspiratory/expiratory) curve.

A

inspiratory

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24
Q

FEV1/FVC <70% =

FEV1/FVC >80% =

A

Obstruction in adults
- Low

restrictive
- normal/increased

*80% is normal

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25
Q

Staging of COPD (gold staging)

- FEV1/FVC < 70%

A

I: mild - FEV1 > 80% predicted
II: moderate - FEV1 50-80%
III: Severe- FEV1 30-50%
IV: very severe- FEV1 <30%

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26
Q

What is vital capacity?

A

IRV + TV + ERV

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27
Q

What is FRC?

A

Amount of air in the lungs after normal respiration

ERV + RV

*usually ~ 3000mL

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28
Q

What is the forced vital capacity (FVC)?

A

Maximal expiration after maximal inspiration

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29
Q

Sulfhemoglobin is a condition caused by irreversible binding of sulfur to the porphyrin ring of heme of hgb. This shifts the oxyhemoglobin dissociation curve to the (right/left).

A

Right

*opposite of methemoglobinemia: shifts curve to the Left. Methemoglobinemia is less able to be tolerated than sulfhemoglobin. Tx with -methylene blue

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30
Q

Blood color of:
Methemoglobin
Sulfemoglobin

A

Methemoglobin: chocolate brown

Sulfemoglobin: dark greenish-black

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31
Q

What shifts the hgb dissociation curve to the left? (5)

A
  1. fetal hgb
  2. carboxyhemoglobin
  3. cold temp
  4. alkalosis
  5. decreased 2,3-DPG (ie: pRBC transfusion, septic shock, hypophosphatemia, hypocarbia)
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32
Q

What shifts the hgb dissociation curve to the Right?

A
  1. Sickle cell
  2. pregnancy
  3. hyperthermia
  4. acidosis
  5. increased 2,3-DPG (chronic anemia, CHF)
  6. Hypercarbia
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33
Q

Alkalosis shifts the oxyhemoglobin dissociation curve to the (Right/Left)

A

Left

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34
Q

CADET face right! mneumonic

A

rightward shift of oxyhemoglobin dissociation curve

  1. Carbon dioxide
  2. Acidosis
  3. 2,3-DPG
  4. Exercise
  5. Temperature
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35
Q

Diffusing capacity of the lung for carbon monoxide (DLCO) is decreased in _____

A

pulmonary embolism

- increase in dead space ventilation -> prevents nl amount of carbon monoxide from being absorbed

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36
Q

DLCO is (increased/decreased) in asthma

A

Increased

  • Increased total lung volumes
  • Increased expiratory times
  • No parenchymal disease
  • Increased amount of CO that can be absorbed.
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37
Q

DLCO is (increased/decreased) in exercise

A

increased

- more blood flow through pulm vessels, more hgb present to bind more CO

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38
Q

DLCO is (increased/decreased) in L->R cardiac shunt

A

increase

- increased blood volume -> overload of pulm circ -> more CO is abs by more blood passing thru pulm vasculature.

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39
Q

“Double peak” appearance in capnography in pts with_____

A

COPD w/ single lung transplant

- 1st peak: from normal (transplanted) lung, and second peak is the exhalation from the native, diseased lung)

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40
Q

In capnography, phase 3-4 is the expiratory alveolar plateau, and represents ____.

A

continued exhalation of CO2 from the lung alveoli

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41
Q

Vital capacity is ?

A

Maximal amt of air that can fill the lungs and participate in gas exchange

TLC - RV
or
TV+IRV+ERV

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42
Q

Forced vital capacity is?

A

Amt of gas that can be forcefully and maximally exhaled from a maximal inhaled volume

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43
Q

Both FEV1 and FVC are reduced with (restrictive/obstructive) lung pathology

A

restrictive

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44
Q

amiodarone is often used for _____ in difficult to control afib or ______

A

rate control

ventricular arrhythmias

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45
Q

Amiodarone is associated with _____ and _____, especially with the use of supplemental O2 and higher FiO2 concentrations.

A

pulmonary fibrosis, pneumonitis

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46
Q

3 Drugs known to cause pulmonary toxicity and fibrosis (dry cough, dyspnea on exertion, decrease in DLCO)

A
  1. Methotrexate
  2. Bleomycin
  3. Amiodarone
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47
Q

B/l recurrent laryngeal nerve injury after thyroid sx can cause _____

A

loss of function of posterior cricoarytenoid m. (the only muscle that abducts the vocal cords) –> unopposed vocal cord adduction –>respiratory distress and failure

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48
Q

Unilateral recurrent laryngeal nerve injury after thyroid sx can cause _____

A

unopposed adduction of ipsilateral vocal cord –> difficulty with phonation but not respiratory distress.

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49
Q

B/l superior laryngeal nerve injury after thyroid sx can cause _____

A

hoarseness and tiring of the voice (no airway compromise)

*superior laryngeal n innervates the cricothyroid membrane

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50
Q

Which West lung zone has the largest dead space ventilation?

A

West zone 1:
higher alveolar pressure > pulmonary arterial and venous pressure
PA > Pa > Pv

  • no pulmonary blood flow in zone 1
  • does not exist in human lung except in positive pressure ventilation
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51
Q

Which West lung zone?
PA > Pa > Pv
Pa > PA > Pv
Pa > Pv > PA

(A = alveolar
a = arterial
v = venous)
A

Zone 1
Zone 2
Zone 3

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52
Q

Most human lung is comprised of which West lung zone?

A

Zone 3
Pa > Pv > PA

*most dependent area of the lung

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53
Q

Why do COPD patients have auto-PEEP?

A

COPD results in loss of elements that keep the lungs open during expiration.

During exhalation, the airways close, resulting in air trapping.

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54
Q

Smoking cessation immediate benefits

A
  1. Decrease cyanide levels (improve oxygen use)
  2. Decrease CO (improve oxygen use)
  3. Decrease nicotine levels (better vasodilation)
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55
Q

What causes a decrease in FRC?

A

mneumonic PANGOS

- Pregnancy, ascites, neonates, GA, Obesity, Supine position

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56
Q

More aggressive strategies for preoxygenation before intubation if 100% FiO2 via face mask isn’t enough in a spontaneously ventilating pt?

A

CPAP or BIPAP

  • replace nitrogen with oxygen in lungs, create O2 reservoir.
  • Provides PEEP

*HFNC mayyy provide intrinsic PEEP

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57
Q

BVM limitations in pre-oxygenating pts

A
  1. Not meant for spontaneously breathing pts
  2. FiO2 can range from 21%-100%
  3. Do not allow for high flows > 15LPM
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58
Q

Corticosteroid administration can take ___ hours after the first dose to see any appreciable changes in airway edema

A

> 12h

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59
Q

Gold standard test for laryngeal edema

A

nasopharyngeal fiberoptic exam
- need cooperative pts and appropriate equipment

*CT and MRI can image, but not safe if pts can have airway compromise at any moment.

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60
Q

How does racemic epinephrine 50/50 mixture help with airway edema?

A
  1. alpha-adrenergic receptor stimulation in airway ->
    Mucosal vasoconstriction, decrease amt of fluid present in the airway
  2. beta-adrenergic stimulation in bronchial tissue ->
    bronchodilation -> prevent bronchoconstriction
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61
Q

Stridor post-extubation (~30-60min) is often the result of ___________

A

laryngeal edema

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62
Q

How does CO poisoning cause lactic acidosis?

A

Formation of CO-hgb –>
less oxygen binding sites and reduction in O2 release –>
decrease O2 delivery to tissues –>
lactic acidosis

*CO binds to hgb < 200x affinity than O2

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63
Q

SaO2 is the ____

PaO2 is the _____

Which one is affected in carbonmonoxide poisoning?

A

Fraction of Hgb that is saturated with Oxygen

Oxygen tension

Both appear Normal in carbonmonoxide poisoning

64
Q

Elimination of CO can be shortened from ____ to ____ (time) with the use of 100% supplemental O2

A

4hours -> 40 min

65
Q

Methemoglobinemia is d/t the oxidation of iron from the ____ to the ___ form, which leads to the inability of heme to ____

A

Fe2+ (ferrous) to Fe3+ (ferric) form

bind oxygen –> diminished oxygen content and less oxygen delivery

66
Q

Important causes of methemoglobinemia (3)

A
  1. Benzocaine
  2. Dapsone
  3. Inhaled nitric oxide
67
Q

Difference between OSA and central sleep apnea

A
  1. Snoring more common in OSA
  2. In CSA, there is no effort to breathe during periods of apnea
  3. CSA is usually secondary to an underlying medical condition (HF, stroke, NM disorders, narcotics, altitude)
  4. CSA can be treated with medications that stimulate breathing (acetazolamide or theophylline)
68
Q

Common sx and symptoms between (7)

  • Obstructive sleep apnea (OSA)
  • Central sleep apnea (CSA)
  • Complex sleep apnea
A
  1. chronic fatigue
  2. daytime somnolence
  3. decreased daytime alertness
  4. decreased ability to concentrate
  5. difficulty staying asleep
  6. mood changes
  7. morning headaches
69
Q

Central sleep apnea (CSA)

  • what is it?
  • how is it diagnosed?
A

brain respiratory centers do not function properly during sleep. Pts fail to trigger inhalation.

  • Apneic period (>10 sec) w/o identifiable respiratory effort
  • > 10 episodes / hr of sleep
  • Glottic opening is present w/o closure
70
Q

Obstructive sleep apnea (OSA)

  • what is it?
  • how is it diagnosed?
A
  • > 5 episodes/hr of complete cessation of airflow during breathing
  • Lasting > 10 seconds despite maintenance of neuromuscular ventilatory effort
  • SaO2 decrease of at least > 4%
71
Q

Diagnosis of OSA is made using ____

A

polysomnography

72
Q

How does CPAP help OSA?

A

Positive pressure keeps pts airway open ->
preventing obstruction ->
preventing hypopnea or apnea

73
Q

How does BIPAP/ASV (adaptive servo-ventilation) help central sleep apnea (CSA)?

A

Higher inspiratory pressure promotes/assists inspiration

Lower expiratory pressure assists expiration in the absence of active ventilation

74
Q

Which one can be treated with mediations to stimulate breathing (OSA/CSA)?

A

CSA

  • Theophylline
  • Acetazolamide
75
Q

In a healthy pt breathing RA, PAO2 will be ___ mmHg

A

100 mmHg

76
Q

In a healthy pt breathing RA, FiO2 will be ___ mmHg

A

0.21

77
Q

Hypoventilation in postop period may result in PaCO2 (increasing/decreasing), and PAO2 (Increasing/decreasing)

A

PaCO2: increase

PAO2: decrease

78
Q

What are the tenants of management to help decrease the risk of leakage across the bronchopleural fistula (BPF)? (4)

A
  1. End expiratory pressure
  2. Short inspiratory time
  3. Low tidal volumes
  4. Low RR
    __________
  5. Can be achieved with Lung isolation
  6. Spontaneous ventilation > Positive pressure ventilation
79
Q

Bronchopleural fistula refers to _____. Ie. from post thoracic surgery on the pulmonary tree, pneumonectomy, lobectomy, malignancy, ARDS, s/p chemo/radiation.

A

leakage of inspired air from the airways to the pleural space for > 24h

80
Q

Bronchopleural fistula Acute clinical presentation: (5)

A
  1. Sudden purulent sputum
  2. Subcutaneous emphysema
  3. Mediastinal/Tracheal shifts
  4. Tension Pneumothorax
  5. Dyspnea
81
Q

Treatment of Bronchopleural fistula if severe and in order of severity (5)

A

Permissive hypercarbia/Spontaneous ventilation

Chest tube or pleural drain

High frequency ventilation

High frequency jet ventilation

EMCO

82
Q

High frequency jet ventilation delivers _____ tidal volumes under ____ pressures at frequencies of _____

A

Small

High

100-200 breaths/min

83
Q

What is closing capacity?

A

The capacity during which airway closure begins to occur.

Consists of closing volume and residual volume

*Obesity and positioning has no effect on CC, but does for FRC

84
Q

Factors that increase closing capacity? (5)

A

Mneumonic: ACLS: S

  1. Age
  2. COPD
  3. LV failure (CHF)
  4. Smoking
  5. Surgery

*All affect transpulmonary pressure across the airways resulting in easier airway collapse at higher lung volumes

85
Q

Which is harder to place, a single or double lumen tube?

A

Double lumen tube
- rigid, larger, odd shape, can only be placed orally

*small mouth openings can be challenging

86
Q

Two most effective methods of isolating the surgical lung?

A

Double lumen tube and

Bronchial blocker
- Passed through the tube and positioned via fiberoptic scope

87
Q

__________ with two lung ventilation is the most important predictor of desaturation in pts who transition to one lung ventilation

A

Arterial PaO2

88
Q

Pts with obstructive lung diseases have (better/worse) PaO2 during one lung ventilation.

A

Better

  • unknown reason
  • Better maintenance of FRC/?
89
Q

(Right/Left) sided lung surgery is a predictor of desaturation.

A

Right

  • has 10% more volume
  • higher chance of increased shunt
90
Q

Gold standard for analgesia in major upper abdominal surgery or thoracotomies

A

mid-thoracic epidural anesthesia

91
Q

Postop pain following major abdominal/intrathoracic surgeries can cause a functional ___________, which decreases inspiratory reserve volume, FVC, and FEV1.

A

Functional restrictive lung disease

92
Q

Airway closure begins (earlier/later) in pts with emphysema compared to pts with normal lungs.

A

Earlier

- loss of supporting structures

93
Q

In normal lungs, the (dependent/nondependant) lung regions will have small airway closure first.

A

Dependent

- greater pleural pressure in the dependent lung regions

94
Q

Airway closure occurs earlier in expiration in older pts bc ______

A

pleural pressure becomes more positive as age increases..

Airway closure can be seen at or above FRC

95
Q

Lung resistance can be divided into _____ and ____

A

Airway resistance

Elastic resistance

96
Q

__________ resistance affects airflow into the lungs. Peak inspiratory pressure (PIP) directly varies with flow resistance.

A

Airway resistance

97
Q

Peak inspiratory pressure (PIP) measures resistance from the ___________ to the _______. It directly varies with ______ resistance.

A

Ventilator tubing to the segmental bronchi

airflow resistance (airway resistance)

98
Q

________ resistance affects the expansion of the lungs. It can also be thought of as the pulmonary compliance. When the elastic resistances increases, pulmonary compliance (increases/decreases)

A

Elastic resistance

Decreases

99
Q

Changes in elastic resistance causes changes in (peak inspiratory pressure/plateau pressure)

A

Both

100
Q

Situations that increase airway resistance (or decrease airflow) will result in increased:
(peak inspiratory pressure/plateau pressure)

  • ie: bronchospasm, kinked ET, airway secretions, mucus plug
A

PIP

*Pplateau remains unchanged

101
Q

Situations that increase the elastic resistance (or decrease compliance) will result in increased:
(peak inspiratory pressure/plateau pressure)

  • Ie: intrinsic pulmonary disease, ascites, abdominal insufflation, tension pneumo, Tburg position
A

Both peak inspiratory pressure and plateau pressure

102
Q

What causes Both peak inspiratory pressure and plateau pressure to increase on anesthesia machine?

A

Situations that increase the elastic resistance (or decrease compliance) will result in increased:
(peak inspiratory pressure/plateau pressure)

  • Ie: intrinsic pulmonary disease, ascites, abdominal insufflation, tension pneumo, Tburg position
103
Q

What causes eak inspiratory pressure to increase but not plateau pressure on anesthesia machine?

A

Situations that increase the elastic resistance (or decrease compliance) will result in increased:
(peak inspiratory pressure/plateau pressure)

  • Ie: intrinsic pulmonary disease, ascites, abdominal insufflation, tension pneumo, Tburg position
104
Q

Severe peripheral neuropathies such as acute inflammatory demyelinating polyradiculopathy (AIDP), aka Guillain-Barre Syndrome (GBS), will tend to cause:

(restrictive/obstructive) pulmonary dysfunction.
How does this affect FEV1 and FVC?

A

Restrictive

  • phrenic and intercostal nerve involvement -> respiratory muscle weakness and diminished ventilatory capacity, both inspiratory and expiratory efforts
  • Once pt is intubated, lung compliance is normal and not restricted. There is no structural issues.
  • decrease in both proportionately
105
Q

Absolute indications for 1 lung ventilation

A
  1. Protective isolation of each lung to prevent contamination of healthy lung (abscess)
  2. Massive hemorrhage control
  3. Bronchopleural fistula
  4. Unilateral cyst or bullae
  5. Trauma
  6. Unilateral lung lavage
  7. VATS
  8. Surgical exposure (Aortic aneurysm, pneumonectomy, lung vol reduction, min invasive cardiac sx , ect)
106
Q

TEE showing flattened interventricular septum with leftward bulge indicates _____

A

RV failure and pulmonary hypertension

*Common during induction of one lung ventilation or reperfusion of transplanted lung

107
Q

Why is RV failure common during induction of one lung ventilation or reperfusion of transplanted lung? How can you initially treat it?

A

Increased hypoxic vasoconstriction -> increased PVR

Tx: Inhaled nitric oxide ->
decrease shunting and decrease PVR by increasing blood flow in the ventilated lung
- other: avoid hypoxia, hypercarbia, maintain normothermia, avoid acidosis

108
Q

Effect of milrinone of PVR and systemic vasculature?

A

Decrease PVR
Increase systemic vasodilation

*can help pulmonary hypertension, but can worsen hypotension

109
Q

The shift of carbon dioxide dissociation curve occurs d/t the ______

A

Haldane effect

110
Q

The process of oxygen binding to hgb and displacing carbon dioxide from the blood is called the _____

A

Haldane effect

  • downward shift of CO2 dissociation curve in physiologic settings with higher oxygen levels (ie. lungs)
  • facilitates removal of CO2 from the body
111
Q

The process in which an increase in CO2 in the blood causes oxygen to be displaced from hgb is called the ______

A

Bohr effect

  • Opposite of haldane effect
  • Rightward shift of oxygen-hgb dissociation curve
112
Q

Boyle gas law

A

Pressure of a gas is inversely proportional to its volume at a constant temp

113
Q

Dalton gas law

A

Total pressure of a gas mixture is equal to the sum pf the partial pressures of the individual gases in the mixture

114
Q

How does CPAP help COPD?

A

Positive pressure keeps pts airway open during INSPIRATION (provides necessary pressure to recruit alveoli that collapsed) and EXPIRATION (keeps alveoli open) ->
Increases lung volume and FRC ->
Increases lung compliance and reduces intrapulmonary shunting ->
Improves V/Q mismatch ->
Improves oxygenation

It also reduces surfactant depletion

*CPAP Helps OSA by:
Positive pressure keeps pts airway open ->
preventing obstruction ->
preventing hypopnea or apnea

115
Q

With CPAP, respiratory rate is _____ and minute ventilation is _____

A

decreased

Increased

  • Minute ventilation is the volume of gas inhaled or exhaled from lungs per min
  • Normal min vent at rest is 5-6 L/min
116
Q

Carboxyhemoglobin level > ___% with neurologic sequelae or cardiac abnormalities is an indication for hyperbaric oxygen therapy

A

> 25%

117
Q

Why does paravertebral anesthesia result in less hypotension than thoracic epidural anesthesia?

A

Unilateral block vs b/l sympathectomy

118
Q

In a pt with an empyema w/ recent lung resection sx, it is assumed that they have a ____ unless proven otherwise

A

Bronchopulmonary fistula

  • avoid positive pressure ventilation until the lungs are isolated from eachother
  • lung isolation is often requested, but not required
119
Q

On the flow volume loop (aka pressure-volume loop), what does pressure overdistension look like? What does it signal?

A

“Bird’s Beak”

  • Sharp rightward deflection
  • Prompt you to reduce driving pressures or delivered tidal volume to prevent volutrauma
120
Q

On the flow volume loop (aka pressure-volume loop), what does volume overdistension look like?

A

Sharp upward deflection with increased FRC

121
Q

In pts with reactive airway disease, use of _____ is the most useful intervention to prevent perioperative bronchospasm during induction

A

Short acting inhaled beta-adrenergic agonists such as racemic albuterol or levalbuterol -> bronchodilator

122
Q

What is the diagnosis post pneumonectomy?

  • PaO2/FiO2 < 200
  • PCWP < 18 mmHg (nl is 12 mmHg)
  • B/l infiltrates on chest radiograph
A

post pneumonectomy pulmonary edema

*PCWP > 18 mmHg is indicative of cardiogenic decompensated HF

123
Q

Carbonic acid is primarily buffered by ______

A

deoxyhemoglobin

124
Q

In metabolic compensation, the kidneys will _____

A

directly excrete H+ in the proximal tubule

125
Q

The majority of physiologic buffers are weak (acid/bases)

A

acids

  • bicarbonate
  • phosphate
  • plasma proteins

*Binds the H+ ions that are produced by the ionization of carbonic acid and prevent a pH change in the serum

126
Q

The plasma level of CO2 and ____ are in equilibrium. CO2 is primarily eliminated ______, and is buffered by _____ in the blood

A

carbonic acid

in the lungs

Hemoglobin

127
Q

Ketorolac is a ______, and can result in a 20% of bronchospasm, so should be avoided in pts with asthma.

A

Cox-1 and Cox-2 inhibitor NSAID

*ASA can also cause bronchospasm

128
Q

(Propofol/Sevoflurane) is better at preventing laryngospasm reflex.

A

Propofol

- thats why you can bolus it if laryngospasm occurs

129
Q

Alternative to measuring DLCO is _____

A

PaCO2 and PaO2

  • from ABG
  • Measurement of gas exchange
130
Q

DLCO is a measurement of ____. It correlates with ____

A

adequacy of gas exchange
- The total functioning surface area of the alveolar-capillary interface

*NOT a measure of respiratory mechanics

131
Q

A DLCO of (greater/less) than 40% is predictive of postoperative respiratory complications

A

Less than 40%

132
Q

_________ is a viable therapeutic option in an anemic pt who refuses blood transfusions

A

Hyperbaric oxygen therapy

133
Q

What electrolyte abnormalities are present in respiratory and metabolic alkalosis?

A

Extracellular shift of H+ ions -> Intracellular shifts of cations

  • hypocalcemia
  • hypokalemia
  • hypophosphatemia
134
Q

The source of hypoxemia in ARDS is _______ caused by diffuse alveolar collapse and atelectasis, and the severity of the syndrome can be characterized by ______

A

a profound shunt

PaO2/FiO2 ratio

135
Q

PaO2/FiO2 ratio:

Mild, moderate, severe ARDS criteria

A

Mild: 201-300
moderate: 100-200
Severe: < 100

136
Q

Emphysema is characterized by a large:

V/Q mismatch / Shunt

A

V/Q mismatch

  • destruction of alveolar membrane, where gas diffusion occurs
  • Large degree of ventilation w/o perfusion
137
Q

What is the effect of hyperoxia on the systemic and pulmonary vasculature?
Why is hyperoxia bad?

A

Causes systemic vasoconstriction and pulmonary vasodilation

Increase circulating reactive oxidative stress

138
Q

When FRC falls below closing capacity, t leads to ______

A

atelectasis, shunt, hypoxemia

139
Q

Causes of restrictive lung disease, and ways to differentiate

A

Intrinsic pulmonary disease
Extrinsic skeletal or muscular disease

CXR

140
Q

RSI is typically used to lung tranplantation bc ______

A

Pts are typically non-fasted

- Emergency basis to minimize graft ischemia time

141
Q

Hypercarbia during lung transplant is ______

A

not recommended

- worsen pulmonary HTN

142
Q

In a healthy pt, the peripheral chemoreceptors begin to stimulate respiratory centers in the brainstem when arterial oxygen tension drops below _____

A

PaO2 of 50 mmHg

aka

arterial oxygen saturation of 85%

143
Q

_________ are responsible for the hypoxic ventilatory response

A

Peripheral chemoreceptors

  1. Carotid bodies
  2. Aortic bodies
144
Q

Obese people have (obstructive/restrictive) lung disease.

Their FEV1:FVC ratio is ____

A

restrictive

> 80%
*80% is normal

145
Q

Apnea-Hypopnea index

  • Normal
  • Mild
  • Mod
  • Severe
A
  • Normal: 0-4
  • Mild: 5-14
  • Mod: 15-29
  • Severe: >30
146
Q

Clinical markers suggesting need for postop mechanical ventilation

A
  1. MG >6 years
  2. Chronic resp disease
  3. Pyridostigmine > 750mg/d
  4. Vital capacity > 2.9L
147
Q

Why is inhalational induction in cystic fibrosis slower than the general population?

A
  1. Increase in FRC
  2. Small TV
  3. V/P mismatch
148
Q

Which inhalational anesthetic is associated with megaloblastic anemia??

A

Nitrous oxide

- inhibits Vit B12 dependent enzymes

149
Q

Hepatopulmonary syndrome manifests as hypoxia in the setting of cirrhotic liver disease d/t ______

A

dysregulation of pulmonary vascular tone

  • Inc R to L intrapulmonary shunt and hypoxia that is resistant to increases in FiO2
  • Orthodeoxia is classic (arterial desaturation in the standing position which improves in lying supine)
150
Q

What is the mixed venous oxygen saturation (SvO2)?

A

marker of tissue oxygen metabolism and provides insight as to whether or not the current cardiac output is meeting the body’s oxygen requirement

151
Q

mixed venous oxygen saturation (SvO2) is proportional to ____ and inversely proportional to ____

A

cardiac output

oxygen utilization

152
Q

Bronchoconstriction is d/t (sympathetic / parasympathetic) stimulation through the ____ nerve

A

parasympathetic

Vagus

153
Q

A foreign body in the R mainstem bronchus will create an intrapulmonary shunt how?

A

Prevent ventilation to a lung that is perfused

- inhalational induction will be slower

154
Q

List common LABAs

A 
salmeterol, 
formoterol, 
arformoterol, 
indacaterol, 
vilanterol,  
olodaterol

all are beta-2 selective

*Initial therapy for COPD with LAMA. Combined LAMA-LABA therapy for patients with severe breathlessness

155
Q

List common Long-acting muscarinic antagonists — The LAMAs (also known as long-acting anticholinergic medications)

A

tiotropium,
aclidinium,
umeclidinium,
glycopyrrolate

*Initial therapy for COPD with LAMA

Anesthesia based on Nebuchanedzzer II (38 decks)

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