OLV- (OLV) Millers fast paced ppt. Newby

Question 1

OLV:

what is OLV

Answer 1

the ability to isolate and ventilate the lungs independently of each other

Question 2

OLV:

what are Pt related reasons for OLV

Answer 2

• Confine infection
• Confine breathing
• Bronchopleural fistula
• Tracheobroncheal disruption
• Lung Cyst
• Severe hypoxemia r/t lung dz (unilateral)

Question 3

OLV:

what are some procedure related reasons for OLV

Answer 3

• TAA
• Lung resection
• thoracoscopy
• Lung transplant
• Esophageal sx
• Ant approach thoracic spine
• Bronchoalveolar lavage

Question 4

OLV:

ways to isolate a specific lung?

Answer 4

• Endobronchiol tube (also known as a main stemmed ETT)
• Bronchial blocker (univent)
• DLT

Question 5

OLV:

Indications for endobronchial tube (ETT)

Answer 5

• inexpensive
• Small internal/external diameters
• Comfort level of provider

Question 6

OLV:

contrainications for ETT

Answer 6

• ability to ventilate only one lung
  
  • no vent for op lung
  • No CPAP/PEEP to op lung

Question 7

OLV:

how is it placed

Answer 7

• DL as per routine
• Once confirmation of tracheal intubation (FOB for anatomical location and placement into specific bronchus)
• Blindly- rotate ETT so bevel is on side lung to be isolated- turn pt’s head contralateral and advance- 92% sucess rate

Question 8

OLV:

Endobronchial blocker indications/ advantages

Answer 8

• Ease of insertion
• Can be positioned during PPV and in any position
• No need for tube exchange
• Can select lobes
• Can apply CPAP

Question 9

OLV:

Endobronchial blocker contraindications

Answer 9

• slow deflation time of op lung
• Slow reinflation time of op-lung
• Possibility of mucus/ blood blockage in BB lumen
• intraoperative leak of BB

Question 10

OLV:

indications for DLT

Answer 10

• lung separation
• increase in op field view

Question 11

OLV:

Contraindications for DLT

Answer 11

• LArge diameter
• Ease of malposition
• Potential damage to airway/ trachealbronchial tree

Question 12

OLV:

how to assess DLT placement w/o FOB for Left DLT

Answer 12

• Inflate tracheal cuff wth 5-10 cc
• check for BBS
• inflate broch cuff w/ 1-2 cc
• Clamp tracheal lumen (should have - right +left)
• Unclamp tracheal lumen
• Check for BBS
• Clamp Broch lumen (shuld have - left +right)

Question 13

OLV:

Anesthestic complications of OLV how does it cause hypoxemia

Answer 13

• Shunt 20-30%
• atelectasis of OP lung
• Blunts HPV
• Decreased Blood flow to dependent lung

Question 14

OLV:

due to the blunting of HPV what will you see on in teh pt

Answer 14

• Very high or Very low PA pressures
• HYPOcapnia
• Very high or Very low Mixed Venous O2 content

Question 15

OLV:

what is treatment for the sideeffects of blunting HPV

Answer 15

• NTG
• SNP
• Beta agonist
• CCB

Question 16

OLV:

how do you manage OLV pt’s

Answer 16

• 2:1
• increased FiO2
• MAintain normal PaCO2
• ABG after induction/and clamp

Question 17

OLV:

what to do if pt becomes hypoxic

Answer 17

• confirm tube placement
• Alter vent to increase MV
• Add 5 cmH2O CPAP to op lung
• Add 5 cmH2O to vented lung
• increase CPAP and PEEP as tolerated

Question 18

OLV:

how do you emerge OLV pts with DLT

Answer 18

• FiO2 1.0
• Unclamp OP lung
• Recruitment manuver
• If remaining intubated excange tube for SLT
• reverse
• spontaneous respiration/ extubate/ FM