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Clinical assessment > Respiratory diseases and anesthesia > Flashcards

Respiratory diseases and anesthesia Flashcards

1
Q

What factors increase anesthesia risk with a respiratory tract infection?

A
  1. underlying resp disease
  2. smokers/second hand
  3. manipulation of airway (intubation vs lma)
  4. within 6 weeks of active infection
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2
Q

Intraoperative management of acute repirtory infection

A
  1. hydrate
  2. reduce secretions
  3. limit manulation

*prophylactic bronchodilators? Not established

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3
Q

Asthma is characterized by

A

REVERSIBLE expiratory airway obstruction

chronic airway inflammation increases resistance

bronchial hyperractiviity = bronchospasm

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4
Q

asthma anesthesia considerations

A
  1. deep anesthesia
  2. steroids before extubation
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5
Q

1 astham pathogenesis/cause

A

Atopy (allergies)

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6
Q

asthma diagnosis flow-volume loop

A

Flow volume loops show characteristic downward scooping of expiratory limb

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7
Q

Asthma diagnosis FEV1 (forced expiratory volume in 1 second) and MMEF (mid-expiratory flow rate)

A

direct measure of airflow obstruction

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8
Q

What helps determine asthma vs airway obstruction

A

where loop is flat helps determine where the obstruction is (inhaled or exhaled portion)

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9
Q

FRC in asthma

A

moderate - severe increased

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10
Q

TLC in asthma

A

remains unchanged

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11
Q

Diffusing capacity for CO and asthma

A

does not change

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12
Q

PaO2 and astham

A

mild asthma PaO2 is normal

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13
Q

Drug classes for asthma

A
  1. anti-inflammatory drugs (corticosteroids)
  2. Bronchodilators (beta agonsits and antocholinergics)
  3. Methylxanthines
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14
Q

In asthma, what indicates intubation?

A

PaCO2 > 50 despite aggressive anti-inflammatory and bronchodilator therapy - respiratory fatigue

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15
Q

Prior to surgery in asthmatic, what does optimization look like

A
  1. peak expiratory flow > 80% predicted
  2. absence of wehezes
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16
Q

Asthma PFTs prior to surgery: what predicts risk for perioperative complications?

A
  1. FEVV1 < 70% predicted
  2. FEV1/FVC ration less than 65%
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17
Q

Asthma induction

A

Propofol > etomidate
Ketamine = bronchodilation (but increases secretions, consider glycopyrolate)

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18
Q

Ventilator strategies in asthma

A
  1. LMA > ETT
  2. decrease inspiratory flow rate, longer exhalation
  3. humidification
  4. avoid histamine
  5. deep extubation/ lidocaine
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19
Q

Bronchospasm presentation

A

rapid increase in peak airway pressure and inability to ventilate (but consider other possibilities as cause)

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20
Q

bronchospasm treatment

A
  1. deepen anesthetic
  2. bronchodilator (albuterol)
  3. corticosteroid administration (hours)
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21
Q

FEV1 range

A

forced expiratory volume in one second

based on age and gender

normal is within 80% of predicted values

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22
Q

What is useful in distinguishing between restrictive and obstructive disesase

A

FEV1/FVC

should be greater than 0.7

less than 0.7 = obstruction

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23
Q

What is best for assessing small airway disease?

A

FEF 25-75

rate of flow occurring in forced expiration between 25-75% of flow

24
Q

what is the most effort independent and reliable measurement of early obstruction?

25
Q

FEV1 and FEV1/FVC - what indicates more sophisticated split lung function tests?

A

FEV1 less than 2 L and
FEV1/FVC less than 50%

26
Q

In intrathoracic obstruction, the problem is

A

expiration

27
Q

In extrathoracic obstructoin, the problem is

A

inpiration

28
Q

Examples of intrathoracic obstruction

A

Tumors of lower trachea
tracheal malacia
tracheal strictures

29
Q

examples of extrathoracic obstruction

A

tracheal tumors
subglottic stenosis
goiter
vocal cord paralysis

30
Q

Dominant feature of COPD

A

progressive airflow obstruction, nonreversible

31
Q

COPD diagnosis

A

chronic productive cough (predominantly chronic bronchitis)

progressive exercise limitations (dyspnea predominantly emphysema)

expiratory flow obstruction

32
Q

RV and FRC in COPD

A

increased (gas is trapped)

33
Q

COPD treatment

A

cessation of smoking and oxygen (if PaO2 < 55 mmHg) supplementation

34
Q

COPD goal PaO2

A

60-80 mmhg

35
Q

Predictors of postoperative pulmonary complications in COPD

A

-current smoker
-advanced pulmonary disease
-Poor nutritional status (low albumin <3.5 mg/dL)

36
Q

Smoking cessation guidelines pre-op

A

6 week pre-op

37
Q

GA irritation bronchi

A

Des most irritating

38
Q

emergence in COPD

A

prolonged d/t secondary air trapping

39
Q

FEV1/FVC and PaCO2 in COPD that may require postoperative ventilatory support

A
  1. FEV1/FVC less than 0.5
  2. PaCO2 > 50
40
Q

Restrictive lung disease is characterized by

A
  1. decrease in ALL lung volumes
  2. decrease in lung compliance
  3. preservation of respiratory flow rates
41
Q

Tidal volumes and respiratory rate in acute intrinsic restrictive

A

Low TV, increased RR

42
Q

acute intrinsic restrictive plateau pressure

A

< 30 cm H2O

43
Q

VC that indicates severe pulmonary dysfuntion

44
Q

most common complication of mediastinoscopy

A

hemorrhage followed by pnuemothorax

45
Q

Pleural effusion

A

accumulation of fluid in the pleural space

46
Q

Respiratory failure
RR
PaO2
PaCO2
A-a gradient

A

RR > 35 or <8

PaO2 <60% at 50% FiO2 or more (in absense of respiratory shunt)

PaCO2 > 55 at 50% FiO2 or more (in absence of respiratory compensation)

A-a gradient >450

47
Q

Nitrous and closed pneumothorax

A

no (OK with functioning chest tube)

48
Q

Pulmonary HTN diagnosis

A

PAP increased by 5-10 mmhg
PA systolic > 30 mmhg and PAP > 20

49
Q

Agents and PVR

A

Ketamine increases PVR

50
Q

anesthetic techniques for pulmonary hypertension

A

Nitric (NO) or IV prostacylcin therapy

51
Q

factors that increase pul htn

A
  1. hypoxemia
  2. hypercapnia
  3. acidosis
  4. hypothermia
  5. hypervolemia
52
Q

Cor pulmonale

A

PAH that has resulted in RV hypertrophy, dilation and cardiac decompression

leading cause: COPD

53
Q

First sign of ARDS

A

arterial hypoxemia resistant to treatment with O2

54
Q

ARDS diagnosis

A

PaO2/FiO2 ration < 200

normal is >500

55
Q

ARDS ventilation

A

Add PEEP to keep PaO2 at least 60 with FiO2 less than 0.5

56
Q

PaO2 in pulmonary embolism

57
Q

Diagnosis of pulmonary embolism

A

Doppler- wheel mill murmer

Clinical assessment (10 decks)

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