Quiz 11 - Lung Disease and Anesthetic Concerns

Question 1

What are the classical triad of symptoms for asthma?

Answer 1

• Wheeze
• Cough
• Dyspnea

Question 2

Preop history - what should you always ask about COPD history?

Answer 2

Smoking history (how long, when did you quit and have you ever smoked)
* Dyspnea - exercise tolerance, home O2 requirement, baseline SPO2 on RA

Question 3

What other preop history would you like to know for COPD?

Answer 3

Productive cough
Wheezing
Admissions to hospital/ER
Prior Surg Hx

Question 4

Preop studies for COPD

Answer 4

SpO2 on RA
ABG
CXR
CBC (may have elevated Hct)
PFT (FEV1 < 2 liters is not good)
Electrolytes (may have elevated bicarb)

Question 5

What FEV1 and FEV1/FVC values would indicate high risk?

Answer 5

FEV1 < 2 Liters

FEV1/FVC < 0.5

Question 6

What are some signs/symptoms of Chronic Bronchitis?

Answer 6

Cough
Sputum production
Recurrent infections
Blue Bloaters

Question 7

What are some causes of Chronic Bronchitis?

Answer 7

Smoking and occupational exposure

Question 8

What are some common characteristics of a “Blue Bloater”?

Answer 8

Short, fat neck
Frequent wheeze
Relatively young
Obese, OSA, Pickwickian syndrome
Cyanotic

Question 9

What are some signs and symptoms of Emphysema?

Answer 9

Progressive dyspnea (SOB)
variable cough
Loss of pulmonary elastic recoil
Pink puffer

Question 10

What are some common characteristics of a “Pink Puffer”?

Answer 10

thin
older
minimal cough
pink color
dyspnea, hyperinflation, distant breath sounds
Pursed lip breathing = auto PEEP

Question 11

What are some causes of emphysema?

Answer 11

smoking
coal miners
alpha-1 antitrypsin deficiency (auto digestion of lung tissue by proteases)

Question 12

What is asthma?

Answer 12

• Airway HYPERREACTIVITY
• Bronchial wall INFLAMMATION
• Degrees of REVERSIBLE airflow dyspnea

Question 13

What is the normal inspiration and expiratory ratio?

Answer 13

1:2

Question 14

What is the inspiration and expiratory ratio for COPD?

Answer 14

1:3

Question 15

What type of drugs should be avoided during broncho spasms?

Answer 15

-HISTAMINE releasing drugs:
     Pentothal
     Morpine
     Atracurium 
     Mivacurium
     Neostigmine

Question 16

Cessation of greater than _____ weeks will reduce post-op pulmonary complications.

Answer 16

8

Question 17

Cessation of smoking 12 hours prior to surgery does what?

Answer 17

• Reduce Carbon Monoxide (COHb)

- Reduce nicotine levels

Question 18

What does nicotine stimulate?

Answer 18

-Sympathetic ganglia - catecholamines released form adrenal medulla - increasing HR BP, and SVR.

Question 19

How long will nicotine stimulation persist for?

Answer 19

-30 minutes after last cigarette

Question 20

What should be done prior to intubation of a smoker?

Answer 20

• Preoxygenate well

- Avoid instrumentation of airwayuntil deep level of anesthesia

Question 21

T/F: Asthmatic bonchitis can only partially reversible.

Answer 21

True (Some degree of obstruction will always remain.