Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Part 2 exam > Periop respiratory > Flashcards

Periop respiratory Flashcards

1
Q

What are the goals of COPD assessment?

A

To determine:
- Severity of airflow limitation
- Severity of symptoms
- Risk of future events (exacerbation, hospital admission, death)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the GOLD crtieria for COPD relating to FEV1?

A

Defined as FEV1/FVC <0.7

GOLD 1: Mild = FEV1 > 80% (needs symptoms) and FEV1/FVC < 0.7
GOLD 2: Moderate = FEV1 50-80%
GOLD 3: Severe = FEV1 30-50%
GOLD 4: Very severe = FEV1 <30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the treatments for COPD?

A
  • Smoking cessation
  • Pharmacological treatment: Bronchodilators: combination LABA + LAMA (long acting muscarinic antagonists), + short acting SABA/SAMA + inhaled corticosteroids
  • vaccinations
  • Pulm rehab
  • Long term Oxygen
  • Surgical or endobronchial interventions
  • Lung transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the pathophysiology of COPD?

A
  • Inflammatory condition that leads to poorly reversible narrowing of the airways, remodelling of smooth muscle and increased number of goblet and mucus secreting glands
  • Characterised by expiratory airflow obstruction due to a combination of small airways inflammation and parenchymal destruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the anaesthetic considerations for COPD?

A
  • Pre op:
    S - functional status and recent control
    C - IHD, smoking
    O - nutritional support (low BMI and albumin are strong predictors of post op complciations)
    M- consider stress dosing if >20mg/day for 3 weeks
  • Intra op issues:
  • Laryngospasm
  • Bronchospasm
  • CVS instability
  • Hypoxia
  • Barotrauma
  • aim for local/sedation/regional
  • monitor for gas trapping
  • lung protective strategies include low RR, longer expiratory times
  • Optomise patient prior to extubation (full reversed, warm, oxygenated, normal PaCO2 for baseline, bronchodilated)
  • consider extubation onto NIV

Post op:
- Analgesia
- Close monitoring
- Suction/physiotherapy/saline nebs for sputum plugging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is asthma?

A
  • reversible airflow obstruction due to airway hyper-responsiveness
  • Bronchial wall inflammation results in mucus hypersecretion, epithelial damage and constriction of airways
  • well controlled asthma -> limited issues
  • poorly controlled asthma -> increased risk of periop pulm complications (bronchospasm, laryngospasm, sputum plugging, atelectasis, infection, resp failure)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are preop considerations for a patient with asthma?

A
  • level of asthma control
  • triggers
  • last attack
  • med hx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the levels of severity for asthma?

A
  • FEV1 (% predicted)
    Mild: 65-80
    Moderate: 50 -64
    Marked: 35 - 49
    Severe : <35
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the anaesthetic implications of asthma?

A
  • Pre op should be asymptomatic and free of wheeze
  • Avoid airway instrumentation
  • Blunt airway relfexes (deep anaesthesia, topical LA, opioids)
  • Bronchodilation, avoid histamine release eg morphine
  • Permissive hypercapnia (increased exp time, decrease RR, adequate tidal volumes, minimise PEEP)
  • Monitor intrinsic PEEP, presence of dynamic hyperinflation
  • Post op monitor for bronchospasm or resp failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is bronchiectasis?

A
  • chronic localised, irreversible dilation of parts of bronchial tree
  • These are inflamed, easily collapsible that lead to airflow obstruction and implaired clearance of secretions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are common causes of bronchiectasis?

A

Acquired:
-necrotising bacterial infections
-chronic partial obstruction e.g. from tumour or foreign bodies

Congenital:
- cystic fibrosis
- ciliary dysmotility – e.g. Kartagener’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are clinical features of bronchiectasis?

A
  • Haemoptysis
  • Recurrent LRTI
  • Chronic cough with purulent sputum
  • positional cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are anaesthetic goals of anaesthetics with bronchiectasis?

A
  • elcucidate cause and severity eg may be CF or systemic disease
  • Optomise per op resp function
    eg delay surgery ? if active sx
    eg Pre op ABx
    eg Pre op chest physio
    eg Regional vs general
    eg increase steroid dose
  • protect healthy lung from soiling of other
    eg induce slightly head up
    consider DL ETT
  • Manage risk of haemorrhage
    due to chronic inflam
    eg large Venous access
    cross match

Post op:
- regular physiotherapy
- monitor sats
- continue ABx post op

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is cystic fibrosis?

A
  • autosomal recessive multisystem disorder
  • Due to issues with gene for Cl- channel transport
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the clinical manifestations of cystic fibrosis?

A
  • Resp: thick secretions, frequent URTI, nasal polyps
  • CVS: right heart failure
  • GIT: portal hypertension, focal biliary cirrhosis, pancreatic insufficiency, bowel obstructions
  • Endo: CF related diabetes, osteoperosis
  • Impaired sweating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are anaesthetic considerations of patients with CF?

A

Pre op:
- Severity and stability etc
- Recent PFTs

Intra op:
- Regional if possible, avoid airway
- Avoid nasal intubations
- consider art line for regular ABGs

Post op:
- Consider HDU
- early extubation
- early chest physio

17
Q

What are the types of sleep disordered breathing?

A
  • OSA
  • Hypercapnic central sleep apnoea (eg Obesity hypoventilation syndrome)
  • Non-hypercapnic central sleep apnoea (common in heart failure)
18
Q

What is the diagnosis of OSA?

A
  • can be assisted with STOP BANG
  • Gold standard is overnight polysomnography
  • AHI > 5 = mild
  • AHI > 15 = moderate
  • AHI > 30 = severe

AHI is the sum of apnoea and hypopnoea episodes divided by sleep duration ( in hours)

Apneoea = ventilation pause >10 secs
Hypopoea = 50% reduction in airflow with spo2 desat >3%

  • Other way is oxyden desaturation index, >5 episodes of desat >4% per hour
19
Q

What are the physiological effects of OSA?

A
  • Increased mortality
  • CVS: HTN, arrhythmia, AMI, CCF, stroke
  • CNS: tiredness, impaired cognitive function, depression
    ENDO: impaired glucose tolerance, dyslipidaemia, increased cortisol, PCOS
20
Q

What are anaesthetic issues with patients with OSA?

A
  • Preop optomisation: - if strong suspicion should have formal sleep study prior to major surgery
  • If signs of CCF or PaCO2 > 48 then should delay surgery until optomised
  • Intraoperative:
  • avoid premeds and opioid spare (multimodal)
  • Plan for difficult BMV + intubation
  • Consider regional
  • Adequate pre-oxygenation and PEEP
  • Extubate fully reversed, awake, sitting up
  • Post op:
  • Have CPAP available
  • Close monitoring as required
  • consider overnight oximetry
21
Q

What is restrictive lung disease?

A
  • conditions where lung expansion is reduced
  • All lung volumes are decreased, decreased lung compliance but expiratory flow rates are preserved
22
Q

What are causes of restrictive lung disease?

A
  • Acute intrinsic eg Pulmonary oedema and its various causes, aspiration
  • Chronic intrinsic eg interstitial lung disease such as sarcoidosis, drug induced pulmonary fibrosis
  • Chronic extrinsic: eg diseases of chest wall, pleura and mediastinum eg skeletal deformities, pleural effusion, pneumothorax, neuromuscular disorders
23
Q

What are anaesthetic implications of restrictive lung disease?

A
  • worsened FRC when lying flat -> quick desat
  • Reduce peak pressure if possible (lung protective ventilation, low TV and high RR)
24
Q

What are the 3 invesigations for pre thoracotomy resp assessment?

A
  1. Respiratory mechanics, FEV1 > 40%
  2. Cardiopulm reserve VO2 max > 15ml/kg/min
  3. Lung parenchymal function, DLCO >40%
25
Q

What are anaesthetic implications of lung transplant?

A

Pre op:
- lung function
- Effect of immunosuppresive therapy

Intra op:
- Pts lose cough reflex below level of anastomosis and do not effectively clear secretions
- Regional if possible
- Place ETT just distal to vocal cords in order to avoid damage to anastomosis site

Part 2 exam (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions