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Advance Anesthesia II > Pulmonary Pathophysiology Part II > Flashcards

Pulmonary Pathophysiology Part II Flashcards

Exam 3

1
Q

Restrictive lung disease?

A

Any condition that interferes with normal lung expansion during inspiration

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2
Q

Restrictive lung disease is characterized by a:

A
  • TLC below 5th percentile
  • Decrease lung volume and compliance
  • Preservation of expiratory flow rates
  • Acute
  • Chronic intrinsic
  • Chronic Extrinsic
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3
Q

Chronic Extrinsic(extrapulmonary) involves:

A
  • Pleura
  • Chest wall
  • Diaphragm
  • Neuromuscular function
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4
Q

Pulmonary edema:

A
  • Edema due to leakage of intravascular fluid into the interstitium of the lungs and into the alveoli
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5
Q

Acute pulmonary edema is caused by:

A
  • Increase capillary pressure (hydrostatic or cardiogenic)
  • Increase capillary permiability
  • Presence of bronchograms on the Chest x-ray
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6
Q

Cardiogenic pulmonary edema is caused by:

A
  • Extreme dyspnea
  • Tachypnea
  • SNS activation(HTN, tachycardia, diaphoresis)
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7
Q

Cardiogenic pulmonary edema is more pronouced in patients with:

A

Increased-permeability pulmonary edema (ARDs)

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8
Q

C-xray may not show evidence of aspiration pneumonitis for:

A

6-12 hrs after the event

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9
Q

When Aspiration symptoms appear are more likely to be in:

A

Right lower lobe

If patient aspirated in supine position

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10
Q

High Altitude edema is pressume to be:

A
  • Hypoxic pulmonary vasoconstriction
  • Increase pulmonary vascular pressures (PVR)
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11
Q

Pulmonary Edema: Anesthesia Management

A
  • Elective surgery should be delay
  • Low tidal volumes 6 ml/kg
  • RR of 14-18 bpm
  • Inspiratory plateua pressures < 30 mmHg H2O
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12
Q

Pharmacologic agents for Pulmonary Edema

A
  • Vasodilators
  • Inotropes
  • Steroids
  • Diuretics
  • Morphine (cardiogenic pulmonary edema)
  • Nitroprusside (effective for preload/afterload reducer)
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13
Q

Aspiration Pneumonitis Aspirates are categorized as:

A
  • Contaminated
  • Acidic
  • Alkaline
  • Particulate
  • Norpaticulate
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14
Q

Pneumonitis?

A
  • Chemical injury
  • Serious complication of GETA
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15
Q

Pneumonitis from periop aspiration is known as:

A

Mendelson’s syndrome

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16
Q

Aspiration pneumonitis is a result of three components:

A
  1. Gastric content into the pharyxn
  2. Contents enter the lungs
  3. Lead to injury
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17
Q

Most common depression of reflexes occur during:

A
  • Anesthesia induction and Emergence
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18
Q

Three aspiration syndromes:

A
  1. Chemical pneumonitis (mendelson’s syndrome)
  2. Mechanical obstruction
  3. Bacterial infection
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19
Q

Hallmark of aspiration:

A

Arterial hypoxemia (first sign)

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20
Q

Other sings of aspiration include:

A
  • Tachypnea
  • Dyspnea
  • Tachycardia
  • Hypertension
  • Cyanosis
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21
Q

Aspiration Chest x-ray will show:

A
  • Infiltrates in peripheral and dependent region(most common)
  • Pulmonary edema (most common)
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22
Q

Anesthesia technique in aspiration:

A

Regional anesthesia > GETA

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23
Q

It is still the standard of care for Aspiration:

A

Cricoid pressure

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24
Q

Mainstay prophylaxis againts aspiration:

A

Keep Patient NPO

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25
Q

Minumun Fasting hours required for Clear liquids?

A

2 hrs

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26
Q

Minimal fasting hours required for Breast milk?

A

4 hours

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27
Q

Minimal fasting hour required for Light meal, animal milk, infant formula?

A

6 hours

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28
Q

Minimal hours required for fatty meal?

A

8 hours

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29
Q

Drugs for Prophylaxis for Aspiration risk:

A
  1. GI stimulants (Reglan)
  2. H2 Antagonist (Cemitidine/Pecid)
  3. PPIs (Omeprazole/Lansoprasole)
  4. Antiacids ( Na+ citrate, Na+ Bicarb, Mag+ trisilicate)
  5. Antiemetics ( Droperidol/Ondansetron)
  6. Antichollinergics ( Atropine, Robinol, Scopolamine)
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30
Q

Actions if vomiting and aspiration occurs during induction:

A
  • Tilt patient head downward or to the side
  • Rapid suction of mouth and pharyxn
  • Intubate
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31
Q

Bronchoscopy is reserved for those who aspirated with

A

Solid material

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32
Q

If severe aspiration:

A

Surgery may be postpone

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33
Q

Patient may be discharge s/p aspiration if no significant symptoms occur:

A

within 2 hours of the incidence

34
Q

Aspiration discharge criteria involves

A
  • PT without symptoms (new cough, wheeze)
  • No decrease in SpO2 > 10% of ProOp levels in RA
  • No A-a gradient > 300 mmHg
  • Negative chest x-ray
35
Q

ARDs Hallmark:

A

Noncardiogenic pulmonary edema

36
Q

Acute lung injury PaO2/FiO2 ratio?

A

< 300 mmHg (regardless of PEEP level)

37
Q

ARDs PaO2/FiO2 ratio?

A

< 200 mmHg regardless PEEP level

38
Q

Most Common event and Risk associated with ARDs:

A
  • Sepsis
  • Bacterial pneumonia
  • Trauma
  • Aspiration pneumonitis
39
Q

Prostaglandin metabolites mediates:

A
  1. Pulmonary vasoconstriction
  2. Alter vascular reactivity
  3. Airway constriction
40
Q

Altered vascular reactivity decreases:

A

Hypoxic pulmonary vasoconstriction

41
Q

Microembolus formation is a common manifestion of:

A

ARDs

42
Q

ARDs Treament goals:

A
  • Maintain oxygenation (main goal)
  • Reduce further lung damage ( main goal)
  • Preserve organ perfusion (most important)
43
Q

ARDs has no definitive Tx. Some approaches include:

A
  • Decrease inflammatory reaction
  • Improve oxygenation
  • Corticosteroids
  • Inhaled nitric oxide
  • Exogenous surfactant
  • ECMO
44
Q

ARDs treatment is

A

Supportive
Correction of Hypoxemia

45
Q

Pressure Controlled Ventilation Clinical conditions:

A
  • Severe asthma
  • COPD
  • Salicylate toxicity
46
Q

Volume-Controlled Ventilation Clinical Conditions:

A
  • Acute lung injury (ARDs)
  • Obesity
  • Severe burns
47
Q

ARDs anesthesia management:

A
  • Avoid Barotrauma and Volutrauma
  • Prevent Atelectasis & Airway closure
48
Q

ARDs Anesthesia management focus on

A

Supporting RV performance with prone positioning

49
Q

Prone Positioning Benefits:

A
  • Improves airway pressure
  • Gas exchange
  • Decrease indicators of Cor Pulmonale
50
Q

Bleomycin?

A
  • Most common of pulmonary injury
  • Pulmonary fibrosis incidence of ~ 20%
  • 1% mortality rate
51
Q

Flail chest Hallmark

A

Paradoxical movement of chest wall at side of injury

52
Q

Flail chest result from:

A
  • Chest trauma
  • Multiple rib fractures
53
Q

Flail chest during inspiration the chest wall is

A

Draw inward

54
Q

During Expiration Flail chest the chest wall is

A

Draw outward

55
Q

Flail chest Mechanical Ventilation:

A
56
Q

Select the image during Flail chest Inspiration and Expiration

A
57
Q

Pneumothorax Categories:

A
  1. Simple Pneumothorax
  2. Communicating pneumothorax
  3. Tension pneumothorax
58
Q

Severity classification of simple pneumothorax

A
  • Small = 15% or less
  • Moderate = 15% - 60%
  • Large = Collapse > 60%
59
Q

Simple Pneumothorax Tx

A
  • Determined by size and cause of injury
  • Catheter aspiration
  • Thoracotomy
  • Closed observation
  • Avoid Nitrous Oxide
60
Q

Affected lung on Communicating Pneumothorax collapses on

A

Inspiration

61
Q

Communicating Pneumothorax Management:

A
  • Cover with occlusive dressing
  • Allows egress of air from inside the thorax to avoid tension pneumothorax
  • Suplemental O2
  • Tube tracheostomy
  • Intibation: Mech Ventilation
62
Q

If the Tension Pneumothorax pressure is too high:

A

Mediastinum shift to opposite Hemithorax

63
Q

Hallmark signs of Tension pneumothorax:

A
  • Hypotension
  • Hypoxemia
  • Tachycardia
  • Increase CVP
  • Increase airway pressure
64
Q

Tension Pneumothorax management:

A
  • Chest decompression with 14g needle on 2nd ICS anteriorly
  • Chest decompression with 14g needle on 4th or 5th ICS laterally
65
Q

Angiocatheter converts Tension Pneumothorax to:

A

Simple pneumothorax

66
Q

Hemothorax?

A

Accumulation of blood in the pleural cavity

67
Q

Thoracostomy if the inital bleeding of Hemothorax is :

A

> 20 mL/kg/hr

68
Q

Thoracostomy is indicated if:

A
  • If bleed subside, but rate remains > 7 mL/kg/hr
  • Chest x-ray worsen
  • Refractory hypotension
  • Failed blood transfusion and decompression
69
Q

Atelectasis Prevents:

A

Respiratory exchange of CO2 and O2

70
Q

Atelectasis is common with

A

General Anesthesia

71
Q

Atelectasis develops:

A
  • Within first few min of induction regardless the vent mode
  • Persist hours to days post anesthesia
72
Q

Atelectasis Common causes:

A
  • Impaired surfactant
  • Compression of lung tissue
  • Absence of diaphragmatic-induced negative pressure
  • Oxygen absorption for Nitrogen-free alveoli
73
Q

Atelectasis Treatment

A
  • Small tidal volume 6 to 10 mL/kg
  • PEEP
  • Vital capacity maneuvers
  • Open lung ventilation
74
Q

Atelectasis Standard Postop measures:

A
  1. CPAP (offers greatest increase FRC)
  2. Incentive spirometry
  3. Deep breathing
  4. Intermittent positive-pressure breathing
75
Q

Pleural Effusion?

A

Abnormal accumulation of fluid in the pleural space

76
Q

Pleural effusion possible causese:

A
  • Blockage of lymphatic drainage from pleural cavity
  • Cardiac failure
  • Redution in plasma colloid osmotic pressure
  • Infection or inflammatory process
77
Q

Pleural effusion treatment

A
  • Tube thoracostomy
  • Thoracentesis
  • Pleurodesis
78
Q

Kyphoscoliosis Clinical features:

A
  • Angles measure by Cobb technique
  • Decrease pulmonary function at curvatures > 60 deg
  • Pulmonary symptoms with curvature > 70 deg
  • Impair gas exchange with curvature > 100 deg
79
Q

Scoliosis is associated with:

A

Malignant Hyperthermia

80
Q

Kyphosis is deformity marked by:

A

Accentuated posterior curvature of the spine

81
Q

Scoliosis is:

A

A lateral curvature of the spine

82
Q

Kyphoscoliosis surgical treatment:

A

Anterior or posterior spinal fusion and instrumentation ( Harrington rod insertion)

Advance Anesthesia II (7 decks)

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