Respiratory Diseases Flashcards
Breathing Mechanics
What happens in inspiration?
- Active contraction of diaphrarm: 75 % of inspiration
- External intercostal muscles: 25 % of inspiration
- Other muscles assist during respiratory compromise
Breathing Mechanics
What happens in expiration?
- Passive recoil of ribcage
- Forced expiration: Internal intercostals and abdominal muscles
- Pursed lip breathing seen in COPD patients (autopeeping)
Accute Upper Respiratory Tract Infection
statistics
Management of Anesthesia for URI
How many weeks before its safe to give anesthesia?
How many weeks for hyper-reactive airways?
what gets decreased by GA?
What can PPV do to infection?
- 4 weeks post -URI safe to give anesthesia
- 6 weeks or more for hyper-reactive airways
- Trachial mucociliary flow and pulm bactericidal activity is decreased by GA
- PPV may force infection deeper into lungs
- Immune response is already altered by surgery and anesthesia
*****cancel case if it has been a shorter period of time***
PeriOperative care of URI
- Regional and peripheral nerve block are great technique
- pulmonary toilet – cough and deep breathe
- recent hx of URI symptom is extremely important
- We also need to know patients travel experience
Coronaviruses
definition
what is “spill over” event
SARS- CoV -2
What are the common signs and symptoms?
What happens in severe cases?
Prevention
- hand washing, covering sneezing or coughing, avoid contact with people with symptoms of respiratory illness
treatment:
supportive
What are Intrisic Lung Diseases?
These Diseases causes either:
- Inflammation and /or scarring of lung tissue
- Fill the air spaces with exudate and debris
Asthma, COPD
What are Extrinsic Lung Diseases?
Diseases involving the chest wall, pleura, and respiratory muscles (respiratory pump) [excursion and inhalation]
- disorders of these structures will cause lung restriction and ventilatory dysfunction
- non- muscular disease of the chest wall
- neuro- muscular disorders (polio)
Obstructive Lung Disease
Asthma is what kind of flow obstruction?
Asthma: chronic airway inflammation and reversible expiratory flow obstruction
What question do we ask patients with Asthma upon assessment?
- How do they look
- How do they sound?
- What are they telling you? [believe when they say their lungs are tight]
- Have they received treatment? Did it help?
- Have they been in this condition in the past? what happened? what made them improve?
—> what are your triggers?
–> when was your last attack?
–> how often do you take your medications?
–> have you been to the ER because of asthma?
–> have you ever been admitted to the hospital because of asthma?
–> have you ever had a breathing tube placed because of asthma?
Spirometric Parameters
Define: Forced expiratory volume in 1 seconf (FEV1)
Volume of air that can be forcefully exhaled in 1 second (80 % - 120% of predicted value = normal)
Spirometric Parameters
Forced Vital Capacity
The max amount of air that can be expelled after deep inhalation (~3.7 L in females, ~ 4.8 L in males)
Spirometric Parameters
Ratio of FEV1 to FVC
75% - 80%
Spirometric Parameters
Forced expiratory flow @ 25% - 75% of vital capacity (FEF25%-75%) Aka Maximim mild-expiratory flow, MMEF)
Measurement of flow through midpoint of forced expiration
Spirometric Parameters
Maximum voluntary ventilation (MVV)
measured over 15 seconds (males 140-180 L/min, females 80-120 L/ min)
Asthma Findings
What will you see when your patients is having a marked asthma attack?
FEV<strong>1 </strong>(% predicted)= 35 -49
FEF <strong>25%-75%</strong> (% predicted) = 30 - 40
PaO2 (mmHg) = <60
PaCO2 = >50 [hypercarbia]
look at severe
Respiratory Flow Volume Curves
Obstructive = problem with exhalation
Restrictive disease: problems with inhalation
Treatment of Asthma
what are controllers and what are relievers?
This is an absolute emergency ( status asthmaticus)
What are the treatments?
Turbutaline and Epi dose
Turbutaline dose: 250 mcg Sub Q
Epi : 400 mcg sub Q
Asthma Management
What type of ventilation?
GA max bronchodilation
VA is also good for bronchodilation
SEVO is a really good thing
What is the goal of preoperative assessment of Asthma?
Goal is to formulate anesthetic plan that prevents or blunts expiratory airway obstruction
- Severity and characteristics of their disease
- General appearance of patient
- Auscultation of lung sounds
- Eosinophil count
- PFTs
- FEV1 before and after bronchodilator use
- Decrease in FEV1 OR FVC of <70% and FEV1/FVC ratio <65% of predicted values – may indicate risk factor for peri-op complications
PreOperative Care for Asthma
- CPT, pulmonary toilet, antibiotics, bronchodilator therapy
- Measurement of blood gasses
- Continue antiinflammatory and bronchodilator therapy
- consider stress-dose steroids
- Ideally, free of wheezing and peak expiratory flow >80 % of predicted
What is Chronic Obstructive Pulmonary Disease?
COPD is a disease of progressive loss of alveolar tissue and progressive airlow obstruction that is not reversible. Pulmonary elastic recoil is lost as a result of bronchiolar and alveolar destruction, often from inhaling toxic chemicals such as are contained in cigarette smoke.
COPD
Risk Factors
S/S
Diagnosis
COPD include
(1) cigarette smoking,
(2) occupational exposure to dust and chemicals, especially in coal mining, gold mining, and the textile industry,
(3) indoor and outdoor pollution,
(4) recurrent childhood respiratory infections, and
(5) low birth weight. α1-Antitrypsin deiciency is an inherited disorder associated with premature development of COPD.
Treatment of COPD
Smoking cessation and long-term oxygen administration are the two important therapeutic interventions that can alter the natural history of COPD.
What s/s are great predictors of postop pulmonary complications
- smoking, diffuse wheezing, productive cough
Strategies to decrease Incidence of Postoperative Pulmonary Complications
What are predictors of post-op pulmonary complications in COPD?
- smoking
- diffuse wheezing
- productive cough
When are PFTs predictive of post-op pulmonary function?
they are really not predictive of postOp pulmonary function
When are PFTs useful?
useful for obtaining baseline functioning and for post Op evaluation
Management of Anesthesiafor COPD
preOperative
Intraoperative Managament of COPD
- is regional anesthesia ok to use?
- GA
- What agents would you choose and why?
- What about maintenance?
- What about emergence?
- Is emergence shorter or longer in COPD patients and why?
-
Regional Anesthesia
- Spinal and Epidural is OK; but we need to becareful in administering epinephrine to patients with poor perfusion
- GA
- You want to choose medications with rapid elimination (desflurane, sevoflurane)
- Emergence is longer
- Be careful with Nitrous
- Ventilation of Patients