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Anesthesia and Co-Existing Diseases > Oral Review: Pulm > Flashcards

Oral Review: Pulm Flashcards

1
Q

Characteristics of asthma:

A

Chronic airway inflammation
Airway wall thickening (severe cases)
Reversible expiratory airflow obstruction

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2
Q

Causes of asthma exacerbations:

A 
Allergens
Exercise
Nighttime/sleep
Chemicals (ASA/NSAIDs, VAs, irritants)
Cold
Infection
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3
Q

S/s of asthma:

A

Wheezing
Middle-sized airways narrowed by bronchospasm & further narrowed by forced exhalation
Cough - can be mucoid
Dyspnea/air hunger

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4
Q

Pre-op assessment of asthma:

A 
Triggers
Severity (med requirements)
Degree of reversibility w/ tx
Current status, symptoms
Prior anesthesia history
Breath sounds, general appearance, etc
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5
Q

Pre-op labs for asthma:

A 
PFTs
ABG
ECG (RH failure)
CBC (eosinophils)
CXR (hyperinflation of lungs)
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6
Q

Pre-op meds for asthmatics:

A

Benzos (anxiety –> bronchospasm)
H2 antagonists (unopposed H1 antagonism –> bronchospasm)
Bronchodilators (albuterol)
Pre-op steroids (if FEV1 is

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7
Q

Overall goal for induction in asthmatics:

A

Blunt airway reflexes and bronchoconstriction response during airway instrumentation

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8
Q

Induction in asthmatics:

A 
EDTA-preserved propofol + ketamine (+/- glyco for secretions)
Opioids (non-histamine)
Lidocaine
VA w/ mask prior to laryngoscopy
LMA if possible
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9
Q

Maintenance in asthmatics:

A

High concentration VA
Sevo/halo are least pungent/irritating
Avoid histamine releasers (sux, atra, miva)

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10
Q

Ventilation goals for asthmatics:

A

Avoid PEEP - they are prone to air trapping
Low RR, high TV, long I:E ratio
Keep peak airway pressure volume control
Liberal hydration of pt and circuit

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11
Q

Tx of intra-op bronchospasm:

A 
FiO2 to 100%
Deepen VA
If no air movement: ketamine, propofol, lido
B2 agonists
IV epi in severe cases or SQ terbutaline
IV corticosteroids
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12
Q

Emergence/post-op care for asthma:

A

Pre-emptive albuterol, IV lido
Deep extubation if possible
If not, try to get patient to SV as early as possible

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13
Q

Characteristics of COPD:

A

Progressive airway obstruction
Chronic bronchitis and/or emphysema
Smoking #1 risk factor

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14
Q

COPD staging:

A

Stage 1: FEV1 > 50% predicted
Stage 2: FEV1 35-49%
Stage 3: FEV 1

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15
Q

“Blue bloaters”:

A 
Chronic bronchitis
Mucus/inflammation obstruction
Moderate dyspnea
PaO2  45
Pulmonary hypertension d/t HPV
Cough and diminished breath sounds
Marked cor pulmonale
Tend to be obese
Poor prognosis
CXR: increased bronchovascular markings
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16
Q

“Pink puffers”:

A 
Emphysema
Obstruction due to loss of recoil
Severe dyspnea
PaO2 > 60, normal PaCO2
Very diminished breath sounds
Better prognosis
Tend to be thin
CXR: hyperinflation with a low diaphragm
17
Q

Smoking cessation timeline:

A

12-24 hours: decreased carbon monoxide and nicotine levels
48-72 hours: decreased carboxyhemoglobin, ciliary function improves, increased airway secretions, hyperreactivity
1-2 weeks: decreased secretions/sputum
4-6 weeks: PFTs improve
6-8 weeks: immune, metabolic function normalizes
8-12 weeks: decreased overall postop M&M

18
Q

Induction in COPD patients:

A

Caution with pre-medication
Hold opioids under monitored and with oxygen on
Ketamine is good for pts who tolerate the CV effects, otherwise propofol
Short-acting NMB
Stay away from histamine releasers

19
Q

Maintenance in COPD patients:

A

Cautious with N2O; can cause rupture of bullae from emphysema
VAs bronchodilate but also attentuate HPV reflex
Increased gradient between PaCO2 and ETCO2

20
Q

Ventilation goals in COPD patients:

A

No PEEP
Large TVs (10-15ml/kg) and low RR (6-10 bpm)
Humidifier in circuit
Consider patient’s baseline CO2 and tolerate hypercarbia based on it
Monitor for air trapping

21
Q

Emergence and post-op management in COPD patients:

A

May need to stay intubated/ventilated for prolonged period, esp. after abdominal/thoracic surgeries
Good pain control to avoid splinting

22
Q

Causes of reduced lung compliance:

A 
Normal compliance = 100-200ml/cmH2O
Increased fibrous tissue
Alveolar edema
Low lung volumes/atalectasis
Increased pulm venous pressure
23
Q

Four types of restrictive lung disorders with examples:

A 
Acute intrinsic (pulm edema, ARDS, aspiration pneumonitis)
Chronic intrinsic (pulm fibrosis, sarcoidosis)
Chronic extrinsic (chest wall/ab/neuromusc diseases, obesity, kyphosis)
D/o of pleura/mediastinum (tumors, pneumothorax, pleural effusions)
24
Q

Describe re-expansion pulm edema:

A

After rapid evacuation of > 1L from pneumothorax/effusion that’s > 24 hours old, due to enhanced capillary membrane permeability

O2, PEEP, no diuretics unless volume overload is primary issue

25
Q

Describe negative pressure pulmonary edema:

A

Minutes to 2-3 hours after acute upper airway obstruction, due to highly negative intrapleural pressure caused by attempting to breath against closed airway

Most often post-extubation laryngospasm; self-limiting in 12-24 hours; tx with O2, airway monitoring, mechanical ventilation + PEEP if needed

26
Q

Tx for aspiration pneumonitis:

A

Increase FiO2
PEEP
B2 agonists for bronchodilation
Bronchoscopy for suspected solid material

27
Q

Describe sarcoidosis:

A

Systemic granulomas
Can be in airway (difficult intubation) and myocardium (CV effects)
Liver, spleen, optic and facial nerves too
Pulm HTN and RH failure
Often on chronic steroids
Prone to hypercalcemia

28
Q

Describe chronic extrinsic lung disease effects:

A

RH dysfunction d/t chronic compression of pulm vasculature

Impaired cough –> chronic infections and obstructive component

29
Q

S/s of pneumothorax:

A 
Acute dyspnea
Decreased PaO2, increased PaCO2
Hypotension
Tachycardia
Uneven/decreased chest wall movement
Hyperresonant percussion
30
Q

Regional anesthesia in restrictive lung disease:

A

> T10 level means loss of accessory muscles which may put patients at risk, plus they don’t tolerate sedation well; not a bad idea for post-op pain though

31
Q

Induction in restrictive lung disease:

A

Titrated pre-meds carefully d/t respiratory depression
Pre-oxygenation critical d/t reduced FRC
May need etomidate if CV comorbidities

32
Q

Maintenance in restrictive lung disease:

A

VA uptake will be faster d/t reduced FRC
Need ETT, not LMA; will need higher pressures
Low TV (4-8ml/kg) and high RR (14-18 bpm)
Avoid excessive FiO2

Anesthesia and Co-Existing Diseases (3 decks)

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