One Lung Ventilation Flashcards
What are indications for one lung ventilation?
Isolation to prevent spillage or contamination such as in infection or massive hemorrhage Bronchopleural fistula Tracheobronchial tree disruption Surgical opening of a major conducting airway
Techniques for lung separation: Bronchial blocker-why would you place this instead of a DLT? What are some cons?
Bronchial blocker (critically ill pts in whom it may not be feasible to place a DLT, already intubated patients, pts with known difficult airway, need for post-op ventilation) Slow lung deflation time, slow lung reinflation time difficult suctioning of operative lung
IF you need to do endobronchial placement of regular ETT-when would you do it and why? Cons? How to place?
Rapid, easy way of effectively separating two lungs especially in cases of massive hemoptysis. In most situations, tube will automatically go to right mainstem. If left mainstem needs to be intubated,turn patients head to right and rotate tube 180 degrees. If entering right main stem bronchus, there is a high probability that right upper lobe bronchus may be blocked off leading to hypoxemia.
Pre-op in OLV patients:
Full cardiac and respiratory physical exam This is considered an intermediate risk surgery per ACC guidelines
What is the gold standard for post-thoracotomy anesthesia and with what solution?
Thoracic epidural analgesia with combo of low dose narcotic and dilute local anesthetic solution
Intra-op with OLV: Verify placement when ? Use what percent O2? Parameters for OLV:
Veify correct placement using auscltainon and direct visualizztion with the fiber optic scope Verify tube placement again once patient is in lateral position. use 100% FiO2 Begin OLV without changing the TV Keep plateau airway pressures at <25 Keeep PaCO2 at 40 mmHg by adjusting respiratory rate
Treatment of hypoxemia in OLV
*If severe, switch to two lug vent 100% FiO2 CPAP to non dependent llung (5-10)-overcomes atelectasis in non ventilated lung, decreasing shunt fraction PEEP to dependent lung (5-10) check position of DLT with fiberoptic bronch If an emergency, have surgeon clamp pulmonary artery
In a left sided DLT, placing fiberoptic scope through tracheal lumen will show what?
view of tracheal carina wiht upper surfce of blue left endobronchial balloon just visible below tracheal caringa off to left .
If the patient must remain intubated after OLV, how will you switch the tube?
Exchange of DLT for single lumen tube via an extended tube exchanger. Requires assistant to remove DLT over a tube changer while direct laryngoscopy is maintained by the Anesthesiologist. The single lumen tube is then threaded over tube changer by the assistant.
Go over the postioning and what you would hear as far as breath sounds if a left sided DLT-in too far on left side, out too far in trachea, in too far on right side
