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Spring 2020 - Physiology 1 > One Lung Ventilation & Malignant Hyperthermia - Quiz 9 > Flashcards

One Lung Ventilation & Malignant Hyperthermia - Quiz 9 Flashcards

1
Q

When is One Lung Ventilation usually indicated?

A

Thoracic Surgery

VATS

Approach via Chest

Unilateral Lung Isolation

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2
Q

What type of Tubes do you use for One Lung Ventilation?

A

Double Lumen ETT

ETT w/ Bronch Blocker

Univent ETT

Endobronchial Intubation

ETT w/ Positive Pressure to One Side

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3
Q

What is the most common positioning for Thoracic Surgery

A

Lateral Decubitus

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4
Q

In lateral decubitus, which lung is the Dependent lung?

A

Lower Lung

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5
Q

In lateral decubitus, which lung is the Nondependent Lung?

A

Upper Lung

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6
Q

For thoracic surgery, how is the surgical field access povided?

A

Iatrogenic Pneumothorax of Upper Lung

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7
Q

What is the Fluid Management for Thoracic Surgery?

A

Restrict IVF d/t risk of lower lung edema

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8
Q

If the patient is awake and in lateral position, which lung is better Perfused & Ventilated?

A

Dependent Lung - Lower Lung

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9
Q

After induction, which lung does positive pressure ventilation and ventilation in general favor more?

A

Upper Lung

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10
Q

What increases the Compliance & Ventilation of the upper lung in lateral position?

A

Open Pneumothorax of Upper Lung

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11
Q

Lung Zone 1

A

PA > Pa > PV

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12
Q

Lung Zone 2

A

Pa > PA > PV

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13
Q

Lung Zone 3

A

Pa > PV > PA

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14
Q

What causes a large Right-to-Left Intrapulmonary Shunt during thoracic procedures?

A

Upper lung is not ventilating, but still perfusing

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15
Q

What does an Increased PA-a (Alveolar to arterial) O2 gradient lead to?

A

Hypoxemia

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16
Q

What decreases blood flow to the nonventilated upper lung and improves the Right-to-Left Shunt?

A

Hypoxic Pulmonary Vasoconstriction (HPV)

&

Surgical Compression of Upper Lung

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17
Q

What factors Inhibit Hypoxic Pulmonary Vasoconstriction (HPV)?

A

Very Low/High PAP or Mixed Venous PO2 (PVO2)

Hypocapnia

Vasodilators

Inhlation Agents

Pulmonary Infections

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18
Q

What factors decrease blood flow to lower lung and worsens Right-to-Left shunt?

A

More blood going to Upper Lung

Increased Airway Pressures

Hyperventilation

Low FiO2

Inadequate Expiratory Time

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19
Q

Vasoconstrictors have a greater effect on _______ vessels compared to ________ vessels

A

Vasoconstrictors have a greater effect on normoxic vessels compared to hypoxic vessels

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20
Q

CO2 elimination is not affected by one lung ventilation except for when?

A

Changes in Minute Ventilation

&

Preexisiting CO2 Retention

21
Q

What should the Tidal Volumes be for One Lung Ventilation?

A

Same as Two Lung - 7-8cc/kg

22
Q

How long can Ventilation be stopped for?

A

As long as O2 supplied is more than consumed

250-300cc/min

23
Q

How fast does PCO2 increase during Apnea?

A

5 mmHg for first minute

then

3 mmHg for each minute after

24
Q

What happens after 10-20 minutes of Apneic Oxygenation?

A

Progressive Respiratory Acidosis

25
Q

How should you intubate to ensure proper ETT placement for one lung ventilation?

A

Use Fiberoptic Scope

26
Q

What do you do for Hypoxia during One Lung Ventilation?

A
  • 80-100% FIO2
  • Check TV & ETT Placement
  • Keep PaCO2 @ 40 mmHg
  • Add 5cm CPAP to Upper Lung & 5cm PEEP to Lower Lung Slowly
  • Clamp Upper PA
  • Return to 2 Lung
27
Q

What is the Criteria for Operability for Pneumonectomy

A

PreOp: FEV1 > 2L

PostOp: FEV1 > 800 mL

Split Lung PFTs if Failed

28
Q

What are the FEV1/FVC and Max Breathing Capacity in high risk patients?

A

< 50% of Predicted

29
Q

What is the RV/TLC for High Risk Patients?

A

> 50% of Predicted

30
Q

What is the Max VO2 for High Risk Patients?

A

< 10 mL/kg/min

31
Q

What is the DLco for High Risk Patients?

A

< 40% of Predicted

32
Q

What are the Characteristics of Double Lumen ETTs?

A
  • Left & Right Types
  • Sizes: 35, 37, 39 (Women), 41 (Men)
  • Longer, Blue Bronch Lumen
  • Shorter Clear Tracheal Lumen
  • Curved Tip
33
Q

What are the possible complications of placing a Double lumen ETT?

A

Laryngitis

Hypoxemia d/t Bad Position

Bronch Trauma d/t overinflated cuff

Accidental Suturing

34
Q

What is the most commonly used Double Lumen ETT?

A

Left Double Lumen ETT - easier to place

35
Q

What triggers Malignant Hyperthermia?

A

Anesthetics Gases & Succinylcholine

36
Q

What is the first and most sensitive sign of Malignant Hyperthermia?

A

Unexplained Tachycardia

37
Q

What is the most specific sign of Malignant Hyperthermia?

A

Increasing EtCO2 @ 2-3X

38
Q

What is the mortality rate of Malignant Hyperthermia?

A

10%

70% w/o Dantrolene

<5 % w/ Early Dantrolene

39
Q

Once symptoms of Malignant Hyperthermia are controlled, what is the dosage to continue Dantrolene?

A

1 mg/kg IV q6h x 72 hrs

40
Q

If a patient is on Dantrolene, what would cause life-threatening Hyperkalemia & Cardiac Depression?

A

Calcium Channel Blockers

41
Q

How does Dantrolene work?

A

Directly on Ryanodine Receptor preventing Calcium Release from the SR.

42
Q

What are late signs of Malignant Hyperthermia?

A

Organ Failure

DIC / Coagulopathy

Rhabdo

Edema / Swelling
Death

43
Q

A patient’s tendency for fever, heat stroke, strabismus, exercise myalgia, cramping, and history of muscle diseases may indicate what?

A

Risk for Malignant Hyperthermia

44
Q

What is the Gold Standard PreOp test for MH?

A

Halothane-Caffeine Contracture Test

45
Q

What is King-Denborough Syndrome?

A

Combination of musculoskeletal diseases and deformities that makes them a risk for Malignant Hyperthermia

46
Q

If the patient has had prior uneventful general anesthetic, does this rule out MH?

A

No!

47
Q

Which age group is Malignant Hyperthermia more common in?

A

Children

48
Q

When do symptoms of MH occur?

A

Usually within 1 Hour, but can be also be hours after exposure

Spring 2020 - Physiology 1 (24 decks)

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