Obstructive Lung Diseases Flashcards

1
Q

Obstructive Lung Disease

A

Obstructive sleep apnea
Asthma
COPD
Miscellaneous

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2
Q

Obstructive Sleep Apnea

A

Not technically an obstructive lung disease
Mechanical breathing obstruction occurs during sleep when pharyngeal muscles relax → chronic hypoxemia ↑CO2 ↓FRC
Obesity = most significant precipitating factor
Risk factor ↑morbidity

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3
Q

STOPBANG

A
○ Snoring
○ Tired
○ Observed apnea
○ Pressure HTN
○ BMI >35kg/m2
○ Age >50yo
○  Neck circumference >40cm
○ Gender M
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4
Q

OSA S/S

A
Habitual snoring, fragmented sleep, daytime somnolence
Comorbidities r/t obesity & hypoxemia
- Systemic & pulmonary HTN
- Ischemic heart disease
- Congestive heart failure
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5
Q

OSA Diagnosis

A
Polysomnography - records # abnormal respiratory events
STOPBANG
Apnea-hypopnea index AHI
Normal <5
Mild 5-15
Moderate 15-30
Severe >30
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6
Q

FEV1

A

Forced expiratory volume in 1 second
TLC 5L
Normal FEV1 = 4L
80-120%

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7
Q

FVC

A

Forced vital capacity
Volume air forcefully exhaled after deep inhalation
Females 3.7L
Males 4.8L

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8
Q

FEV1:FVC Ratio

A

Normal 75-80%

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9
Q

FEV 25-75%

A

Air flow measurement at midpoint forced exhalation

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10
Q

Maximum Voluntary Ventilation

A

MVV
Maximum amount air inhaled & exhaled in 1 minute
Females 80-120L/min
Males 140-180L/min

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11
Q

DLCO

A

Diffusion capacity
Patient inhales helium & carbon monoxide
Measures volume CO transferred across the alveoli into the blood per minute per unit alveolar partial pressure
Single breath 0.3% CO + 10% helium held for 20 seconds
Normal value 17-25mL/min/mmHg

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12
Q

Acute Upper Respiratory Infection

A

Common cold
Infectious (viral or bacterial) nasopharyngitis 95%
S/S:
- Non-productive cough
- Sneezing
- Rhinorrhea
- Bacterial include fever, purulent nasal discharge, productive cough, & malaise

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13
Q

Acute Upper Respiratory Infection

Anesthetic Management

A

Hydration
↓secretions
Limit airway manipulation
LMA vs. ETT

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14
Q

Asthma

A
REVERSIBLE airway obstruction
- Bronchial hyperreactivity
- Bronchoconstriction
- Lower airways chronic inflammation
Genetic & environmental
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15
Q

Asthma Pathophysiology

A

Inflammatory pathway activation → airway mucosa infiltration w/ eosinophils, neutrophils, mast cells, T/B cells, & inflammatory mediators
→ EDEMA

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16
Q

Asthma S/S

A

Wheezing, productive/non-productive cough, dyspnea, chest tightness, SOB, airflow obstruction
FEV1 <35% ↑FRC
TLC = WNL
DLCO unchanged
CXR hyperinflation d/t air trapping
R ventricle strain T wave inversion V1-4 & II, III, aVF

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17
Q

Asthma Treatment

A
Corticosteroids
Long-acting bronchodilators
Leukotriene modifiers
Anti-IgE
Methylxanthines
Mast cell stabilizer
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18
Q

Status Asthmaticus

A
Life-threatening emergency
Bronchospasm does not respond to treatment
β2 agonists
IV corticosteroids
Supplemental O2
IV magnesium sulfate
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19
Q

Asthma Anesthetic Considerations

A
Regional vs. general anesthesia
↓airway manipulation
Propofol & Ketamine - bronchodilation
IV or transtracheal Lidocaine
Sevoflurane less pungent
Light anesthetic potential bronchospasm
Avoid histamine releasing drugs
20
Q

COPD

A

Chronic obstructive pulmonary disease
NONREVERSIBLE loss alveolar tissues & progressive airway obstruction
Type A - Emphysema (pink puffers)
Type B - Chronic bronchitis (blue bloaters)

21
Q

COPD Risk Factors

A
Cigarette smoking
Occupational exposures
Pollution
Recurrent respiratory infections
Low birth weight
Antitrypsin deficiency
22
Q

Chronic Bronchitis

A

Type B
Characterized by excessive sputum production
- Mucus gland hypertrophy
- Small airway inflammatory changes
- Tissue granulation
- Peri bronchial fibrosis
Clinical S/S indicate pulmonary complications

23
Q

COPD Spirometry

A
Normal lung volumes
↓FEV1/FVC ratio
↓FEV 25-75
↑FRC & TLC 
Severity determined by GOLD criteria
24
Q

COPD Treatment

A

Designed to relieve symptoms & slow disease progression

  • Smoking cessation
  • Oxygen
  • Long-acting β2 agonists
  • Inhaled corticosteroids
  • Long-acting anticholinergic
  • Lung volume reduction surgery
25
Q

Lung Volume Reduction Surgery

A
Remove worse lung portion to optimize remaining
Severe COPD
↓V/Q mismatch
Double-lumen ETT
Avoid N2O
One lung ventilation
VT 3-4mL/kg IBW
26
Q

COPD Anesthetic Considerations

A
Preop pulmonary function test
Hypoxemia ↑PaCO2
Baseline HCO3¯ (renal compensation)
Determine response to bronchodilators
CV involvement R ventricle function
Desflurane → irritation
Avoid N2O attenuates HPV ↑V/Q mismatch
Limited opioid & benzodiazepine use (prolonged ventilatory depression)
27
Q

Smoking Cessation

A

At least 6 weeks prior to surgery
Benefits seen w/in 4-6hr
Immediate cessation NOT recommended

28
Q

Auto PEEP

A

Air trapping
Capnography - expiratory flow does not reach baseline before next breath
+ pressure ventilation PPV applied w/o adequate expiration ↑intrathoracic pressure ↓VR ↑pulmonary artery pressure → R heart strain

29
Q

Bronchospasm Treatment

A
Deepen anesthetic
Short-acting bronchodilator
Suction secretions
IV steroids
Epinephrine
30
Q

Expiratory Outflow Obstructions

A
Bronchiectasis
Cystic Fibrosis
Primary ciliary dyskinesia
Bronchiolitis obliterans
Tracheal stenosis
31
Q

Bronchiectasis

A

Irreversible airway dilation & collapse resulting from inflammation d/t chronic infections
Significant hemoptysis 200mL over 24hr
Resultant airway collapse ↑recurrent infection risk

32
Q

Bronchiectasis S/S

A
Chronic cough w/ purulent sputum
CT imaging to confirm
Hemoptysis
Pleuritic chest pain
Dyspnea
Wheezing
Finger clubbing
33
Q

Bronchiectasis Anesthetic Considerations

A

Delay elective procedures until patient optimized
General anesthesia w/ ETT
- Frequent suctioning
- Avoid nasal intubation
- Double lumen tube prevent cross-contamination

34
Q

Cystic Fibrosis

A

Autosomal recessive disorder
Chromosome 7
Prevents chloride transport & Na+/H2O movement in & out cells
→ abnormally thick sputum production outside epithelial cells
1° cause morbidity & mortality chronic pulmonary infection

35
Q

Cystic Fibrosis Diagnosis

A
Sweat chloride >70mEq/L
Chronic purulent sputum production
Malabsorption (pancreatic enzyme therapy)
Bronchoalveolar lavage ↑neutrophils
COPD common in adult patients
36
Q

Cystic Fibrosis Treatment

A
Directed toward symptom alleviation
- Clear airway secretions
- Correct organ dysfunction
- Nutrition (impaired ability to absorb nutrients)
- Prevent intestinal obstruction
Gene therapy (?)
37
Q

Cystic Fibrosis Anesthetic Considerations

A

Delay elective procedures until patient optimized
- Control infection & remove secretions
Vitamin K treatment (fat-soluble vitamins absorption)
General anesthesia w/ volatile agents
AVOID anticholinergic medications
Awake extubation
Adequate pain control

38
Q

Primary Ciliary Dyskinesia

A

Congenital ciliary activity impairment in the respiratory tract & sperm cells
Pulmonary infections
Organ inversion

39
Q

Kartagener’s Syndrome

A

Chronic sinusitis
Bronchiectasis
Situs inversus

40
Q

Primary Ciliary Dyskinesia Anesthetic Considerations

A
Regional anesthesia preferred
Dextrocardia - reverse EKG placement
L IJ central line
R uterine displacement (term mothers to prevent vena cava compression)
Avoid NP airways d/t sinusitis risk
41
Q

Bronchiolitis Obliterans

A

Small airways & alveoli disease in children d/t RSV
Lower bronchioles destruction
Adults d/t viral pneumonia, collagen vascular disease (RA), silo filler’s disease (NO2 inhalation), or graft vs. host disease

42
Q

Bronchiolitis Obliterans Organizing Pneumonia

A

BOOP
Similar features as interstitial lung disease
Treatment typically ineffective S/S management
Corticosteroid ↓swelling
Bronchodilators to optimize the airway diameter

43
Q

Tracheal Stenosis

A

Tracheal mucosa ischemia → scarring

Prolonged intubation or cuff over-inflation

44
Q

Tracheal Stenosis S/S

A

Adult symptomatic when tracheal diameter <5mm
Dyspnea even at rest
Accessory muscle use during inspiration & expiration
Flow loops flattened inspiratory & expiratory curves

45
Q

Tracheal Stenosis Treatment

A
Dilation = temporary measure
- Balloon or surgical dilators
- Laser scarred tissue
Tracheobronchial stent 
Best treatment = tracheal resection w/ anastomosis
46
Q

Tracheal Stenosis Anesthetic Considerations

A

Translaryngeal intubation
Volatile agents to ensure maximum inspired oxygen concentration
Helium ↓gas mixture density & improves flow