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Principles semester 2 > 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
FEV1 and FEV1/FVC - what indicates more sophisticated split lung function tests?
FEV1 less than 2 L and FEV1/FVC less than 50%
26
In intrathoracic obstruction, the problem is
expiration
27
In extrathoracic obstructoin, the problem is
inpiration
28
Examples of intrathoracic obstruction
Tumors of lower trachea tracheal malacia tracheal strictures
29
examples of extrathoracic obstruction
tracheal tumors subglottic stenosis goiter vocal cord paralysis
30
Dominant feature of COPD
progressive airflow obstruction, nonreversible
31
COPD diagnosis
chronic productive cough (predominantly chronic bronchitis) progressive exercise limitations (dyspnea predominantly emphysema) expiratory flow obstruction
32
RV and FRC in COPD
increased (gas is trapped)
33
COPD treatment
cessation of smoking and oxygen (if PaO2 < 55 mmHg) supplementation
34
COPD goal PaO2
60-80 mmhg
35
Predictors of postoperative pulmonary complications in COPD
-current smoker -advanced pulmonary disease -Poor nutritional status (low albumin <3.5 mg/dL)
36
Smoking cessation guidelines pre-op
6 week pre-op
37
GA irritation bronchi
Des most irritating
38
emergence in COPD
prolonged d/t secondary air trapping
39
FEV1/FVC and PaCO2 in COPD that may require postoperative ventilatory support
1. FEV1/FVC less than 0.5 2. PaCO2 > 50
40
Restrictive lung disease is characterized by
1. decrease in ALL lung volumes 2. decrease in lung compliance 3. preservation of respiratory flow rates
41
Tidal volumes and respiratory rate in acute intrinsic restrictive
Low TV, increased RR
42
acute intrinsic restrictive plateau pressure
< 30 cm H2O
43
VC that indicates severe pulmonary dysfuntion
<15 mL/kg
44
most common complication of mediastinoscopy
hemorrhage followed by pnuemothorax
45
Pleural effusion
accumulation of fluid in the pleural space
46
Respiratory failure RR PaO2 PaCO2 A-a gradient
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
Nitrous and closed pneumothorax
no (OK with functioning chest tube)
48
Pulmonary HTN diagnosis
PAP increased by 5-10 mmhg PA systolic > 30 mmhg and PAP > 20
49
Agents and PVR
Ketamine increases PVR
50
anesthetic techniques for pulmonary hypertension
Nitric (NO) or IV prostacylcin therapy
51
factors that increase pul htn
1. hypoxemia 2. hypercapnia 3. acidosis 4. hypothermia 5. hypervolemia
52
Cor pulmonale
PAH that has resulted in RV hypertrophy, dilation and cardiac decompression leading cause: COPD
53
First sign of ARDS
arterial hypoxemia resistant to treatment with O2
54
ARDS diagnosis
PaO2/FiO2 ration < 200 normal is >500
55
ARDS ventilation
Add PEEP to keep PaO2 at least 60 with FiO2 less than 0.5
56
PaO2 in pulmonary embolism
decreased
57
Diagnosis of pulmonary embolism
Doppler- wheel mill murmer

Principles semester 2 (17 decks)

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