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Respiratory Anesthesia > Respiratory Physiology & OLV > Flashcards

Respiratory Physiology & OLV Flashcards

1
Q

Choanal Atresia

A

obstruction of airway in obligatory nose-breathing newborns

-Choanal derives from Conchae/turbinates

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2
Q

What level does the pharynx extend too & what does it become continuous with?

A

Extends to C6 & becomes continuous w/ esophagus

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3
Q

Where might an ingested body most likely be found?

A

Level of C6
-Laryngopharynx from tip of epiglottis to C6 (beginning of esophagus)

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4
Q

What level is the Larynx found in adults?

A

C3-C6

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5
Q

What are the paired cartilages of the Larynx

A

Arytenoid
Corniculates
Couneiforms

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6
Q

Narrowest part of adult airway

A

At Vocal Cords

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7
Q

Narrowest part of pediatric airway

A

BELOW VC

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8
Q

What muscle closes the vocal cords?

A

Aryepiglottic muscle

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9
Q

What muscle opens the vocal cords?

A

Thyroepiglottic muscle

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10
Q

What do the vocal cords attach to anteriorly?

A

Thyroid

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11
Q

What do the vocal cords attach to posteriorly?

A

Arytenoids

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12
Q

The RLN innervates ALL muscles of the larynx EXCEPT….

A

Cricothyroid & part of the interarytenoid muscles

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13
Q

Unilateral damage to the RLN will present with…

A

Hoarseness

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14
Q

Bilateral damage to the RLN will present with…

A

Dyspnea

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15
Q

What are some causes of damage to the RLN?

A

Neck surgery, airway devices, regional anesthesia/blocks

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16
Q

At what level is the carina?

A

T4-T5

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17
Q

What is the estimated diameter of the trachea?

A

2.5cm

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18
Q

How many centimeters are from the incisors to the larynx?

A

13 cm

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19
Q

How many centimeters are from the larynx to the carina?

A

13 cm

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20
Q

Total centimeters from incisors to carina? Relevance?

A

26 cm
-Subtract a few cm and where our ETT is to sit. Just above the carina.

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21
Q

Which bronchi has the lesser degree angle? What degree?

A

Right bronchus. 25 Degrees. More likely to mainstem & food bolus

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22
Q

What innervates the bronchi? (2)

A

Sympathetic & vagus nerves

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23
Q

Function of Type 1 Pneumocytes

A

Structure

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24
Q

Function of Type 2 Pneumocytes

A

Produce surfactant that reduce alveolar collapse

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25
Q

Function of Type 3 Pneumocytes

A

Macrophages

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26
Q

What physical law/gas law is represented by the mechanics of inspiration?

A

Boyle’s Law
-Volume & Pressure inversely proportional @ constant temperature

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27
Q

Which nerve innervates the diaphragm & what is its origin?

A

Phrenic = C3-C5
“Keeps the diaphragm alive”

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28
Q

Lung compliance

A

change in volume / change in pressure

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29
Q

What 6 components may decrease Static Compliance?

A
  1. Fibrosis
  2. Obesity
  3. Vascular engorgement
  4. Edema
  5. ARDS
  6. External compression
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30
Q

What is the ONLY component that INCREASES Static compliance?

A

Emphysema

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31
Q

What is the normal range in mL/cm H2O for Static Compliance?

A

60-100 mL/cmH2O

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32
Q

What is Static Compliance?

A

***Compliance of JUST the lungs & chest wall
**Useful evaluating conditions that affect lung parenchyma or chest wall
-Measured when no air moving in lungs

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33
Q

Static compliance decreases with fibrosis, ARDS, pulmonary edema which makes it more difficult for the lungs to ___________

A

Expand

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34
Q

Why does the Law of LaPlace not apply to the lungs/alveoli?

A

Because of the surfactant produced by type II pneumocytes.
** Aids in lowering alveolar surface tension = prevents collapse
-Phospholipid dipalmitoyl lecithin”

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35
Q

What role does surfactant have in the lungs & alveoli?

A

*Aids in lowering alveolar surface tension = preventing collapse
*Lowering surface tension in smaller alveoli prior to large to prevent from collapsing/emptying into large

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36
Q

At what age gestation is surfactant produced?

A

28-32 weeks
*Produced fully at 35 weeks

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37
Q

Define Law of LaPlace

A

At constant surface tension
-Pressure increases & radius decreases

Pressure & radius inverse relationship

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38
Q

Reynolds number >4000 indicates

A

Turbulent flow

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39
Q

Reynolds number <2000 indicates

A

Laminar flow

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40
Q

Is laminar flow seen more in smaller airways or larger airways?

A

Smaller airways

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41
Q

40% of airway resistance is in the __________ airways. Consisting of…. (3)

A

Upper airways have more resistance –> greatest resistance is in medium sized bronchi
**Bends = increase resistance
-Nasal cavity, pharynx, larynx

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42
Q

What physical law describes a resistance to laminar flow?

A

Poiseuille’s Law

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43
Q

Ill Tell Eddie Rabbit IF Victor Rabbit Tells

A

50-10-20-20

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44
Q

Obstructive lung diseases have _______ resistance

A

Increased resistance which restricts airflow through airways
*Gas trapping leads to blebs = barrel chest & increased lung volumes
-Increased/prolonged exhalation time

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45
Q

Restrictive lung disease have decreased ________ & ________

A

compliance & volumes
-Fibrosis, scoliosis, obesity, pregnancy etc

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46
Q

FEV1

A

80% of vital capacity can be exhaled in 1 second

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47
Q

Closing volume

A

Amount of air left in the alveoli at the moment they begin to collapse (expiration after small airways close)

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48
Q

What happens if the closing volume is greater than functional residual capacity?

A

Airways collapse & can no longer participate in gas exchange but still receive blood flow.
*Intrapulmonary shunt develops = more at risk for hypoxemia

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49
Q

Although the elastic recoil of surrounding tissues help keep alveoli expanded, the alveoli ar PRIMARILY DEPENDENT on _______________ to keep them open

A

Lung Volume

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50
Q

What is Closing Capacity?

A

closing volume + residual volume

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51
Q

What happens if the FRC is greater than CC?

A

Airways stay open

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52
Q

What happens with closing capacity as we age?

A

Typically increases
-44yo –> CC & FRC = in supine position
-65yo –> CC & FRC = in upright position
-Closing volume increases up to 55% at 70yo

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53
Q

What pulmonary conditions have an increased closing capacity?

A

Asthma, COPD, pulmonary edema

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54
Q

Anatomic dead space

A

volume of conducting airways/thickened walls with NO gas exchange
-2mL/kg

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55
Q

Alveolar dead space

A

Alveoli that are ventilated but NOT perfused
-Calculated using Bohr’s equation

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56
Q

Regarding alveolar dead space & Bohr’s equation, what is the total surface area for gas exchange?

A

Total surface area for gas exchange is 60-80 m2

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57
Q

What is PACO2 inversely proportional to?

A

Alveolar ventilation
-Yet as alveolar ventilation increases, PAO2 increases slightly but does not work in the parallel fashion

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58
Q

How many bronchial arteries are there?

A

1 right
2 left

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59
Q

Why is the pulmonary vascular resistance (PVR) an estimated 1/8 (12.5%) of SVR?

A

Short vessels, decreases resistance
***Poiseuille’s Law
-Can increase PEEP as long as no cardiac compromize to improve gas exchange

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60
Q

Bronchopulmonary Anastomose

A

-Normal anatomic shunt where deoxygenated blood from right trickles into the left side of the heart = mixing of oxygenated & deoxygenated blood
***Clinical significance –> bypass needs a left atrial drain to avoid over distension of the drained deoxygenated blood ??????

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61
Q

Pulmonary blood flow is “opposite” of systemic circulation. Why?

A

High O2 tension & hypocapnia increase blood flow via vasodilation = increases O2 uptake

-Hypercarbia & acidosis cause vasoconstriction

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62
Q

Hypoxic Pulmonary Vasoconstriction (HPV)

A

Protective mechanism that occurs during hypoxia where blood is diverted from hypoxic/atelectatic alveoli to precapillary site to improve V/Q

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63
Q

Volatile anesthetics & hypoxic pulmonary vasoconstriction

A

Volatile anesthetics inhibit HPV @ ~1.5 MAC

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64
Q

West zone 1 in upright lung

A

-Alveolar dead space
-Alveoli are ventilated but NOT perfused
-A > a > v
* V/Q > 1

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65
Q

West zone 3 in upright lung

A

*Dependent
-Continuous blood flow because fluids take path of least resistance/gravity
-Tip of PA catheter = communication w/ left heart
-a > v > A
*V/Q <1 = SHUNT because blood is flowing past but cannot ventilate
-“Direct column of blood between RV & LA”

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66
Q

West zone 2 upright lung

A

Continually changing bc of alveolar & vascular pressure changes
*V/Q ~ 1

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67
Q

Pulmonary Edema

A

Colloid & oncotic pressures messed up = things leak into interstitium or alveoli
***Disrupts gas exchange by increasing the space for allowed gas exchange
**O2 effected&raquo_space;> CO2 bc CO2 is 20x more diffusible

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68
Q

Neurogenic pulmonary edema

A

Often caused by an increase in sympathetic discharge. More chemical in nature.
ex) TBI

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69
Q

Negative Pressure Pulmonary Edema (NPPE)

A

Forced inhalation against a closed glottis
*Acute decrease in intrathoracic pressure pulls fluid from the pulmonary capillaries

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70
Q

Why should you consider giving steroids in the treatment of Pulmonary Edema?

A

Membrane Stabilizers & antiinflammatory properties

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71
Q

Why might morphine be used in the treatment of pulmonary edema?

A

Can reduce preload & has pulmonary vasodilating properties

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72
Q

Ventilation but NO Perfusion

A

Dead space
-“Not defined or infinity”

73
Q

Ventilated but POOR perfusion

A

Shunt

74
Q

Increased or high airway pressures effect ventilation & perfusion how?

A

Alveoli may be ventilated but not perfused because so much pressure the pulmonary vasculature become “squished” which decreased blood flowing past.
*Low cardiac output states = low pulmonary blood flow = dead space
-ETCO2 & PACO2 gradient increases

75
Q

In supine position with GA, what causes the atelectasis & 10% shunt?

A

-Decreased FRC
-PPV (although more uniform ventilation) there is a decrease in CO
-Drop in CO (likely preload)
PEEP

76
Q

Each gram of Hgb can combine with how many mL of O2?

A

1.34 mL of O2 = Hgb Carrying Capacity

77
Q

What scant amount of O2 is dissolved in blood?

A

0.003 mL of O2/ 1mmHg of PO2 in 100mL of whole blood

78
Q

A shift right in the oxyhemoglobin dissociation curve does what? Why? In what states?

A

Releases O2
Tissues need it
Often increased metabolic states

79
Q

Bohr Effect

A

Influence of pH and PCO2 on oxyhemoglobin dissociation curve
*BohR = shifts right to RELEASE O2

80
Q

What is methemoglobinemia caused by? (2 factors). What state is the iron in?

A

Nitrate overdose (NTG) or locals (prilocaine, benzocaine)
-FerriC = Fe3+

81
Q

Methylene blue dosage

A

“Methylene Blue = 1 to 2”
* 1-2 mg/kg over 5min

82
Q

80-90% of CO2 is transported via_____

A

Bicarbonate Ions

83
Q

The Haldane Effect shifts the oxyhemoglobin dissociation curve to the __________?

A

HaLdane = LEFT
-Holds on to O2 molecules

84
Q

Caution correcting respiratory acidosis with NaHCO3 in mechanically ventilated patients. Why?

A

Can worsen acidosis d/t an increase in CO2
-HCO3 + H2O dissociates into CO2

85
Q

At what pH would you consider treating metabolic acidosis with NaHCO3?

A

Only if pH <7.20
-Use base deficit to determine extent of resuscitation needed = total bicarbonate deficit

86
Q

Base deficit

A

-Indicator/value to degree of metabolic acidosis
- aka Total body Bicarbonate Deficit
-Often from hypovolemia

87
Q

Base deficit total correction calculation

A

Normal Bicarb - Base Deficit x kg x 0.3
ex) (24-10)(0.3)(80kg) = 336 meq/L

88
Q

Bicarbonate replacement guidelines in metabolic acidosis

A

-Calculate total correction needed
-Replace 50% over first 3-4hrs
-Replace additional 50% over next 6-12hrs

89
Q

Why must one be cautious fluid resuscitating/correcting metabolic acidosis w/ crystalloids & or/ NaHCO3?

A

-Hyperchloremic metabolic acidosis
-Increased CO2 from Henderson Hassalbach equation

90
Q

Herring Breur Reflex: Inflation

A

Prevents over distension of alveoli & transient apnea

91
Q

Herring Beur Reflex: Deflation

A

Increased ventilation when lungs are deflated abnormally
*Clinical ex = Pneumothorax

92
Q

Paradoxical reflex of Head

A

Partial block of phrenic nerve = deeper breath instead of apnea
*Clinical ex = Baby’s first breath

93
Q

Hering nerve

A

Afferent nerve from Carotid Body
-Branch of Glossopharyngeal nerve (CN9)

94
Q

What are the 3 causes of decreased FEV1 (progressive airflow obstruction) in COPD?

A
  1. Decreased intrinsic size of bronchial lumen
  2. Increased collapsibility of bronchial walls
  3. Decreased elastic recoil
95
Q

Moderate IIA COPD classification

A

FEV1/FVC >/= 70%
FEV1 <50 %

**Only class that will have an increase FEV1/FVC ratio >70%

96
Q

Severe COPD classification

A

FEV1/FVC <70%
FEV1 <30%
Presence of right sided or respiratory failure

97
Q

How do opiates & anesthetics affect minute volume & PaCO2?

A

Decrease Ve
Increased PaCO2

98
Q

What is present in 2/3 of severe COPD patients that can be seen on arterial BP monitoring?

A

Pulsus Paradoxus
-Drop in >10mmHg with inspiration
*R/t severe airflow obstruction, increased intrathoracic pressure = decrease in preload & CO

99
Q

What does a low FEV1 correlate with in a pulmonary assessment?

A

Coronary Artery disease & increased mortality

100
Q

What FEV1 value would indicate the need for pulse oximetry & ABG evaluation which may require postop ventilation (discuss & document)

A

FEV1 <1.5L

101
Q

Why might nitrous oxide be contraindicated in COPD?

A

Bullae rupture
-Remember nitrous oxide is highly diffusible & rapidly fills air-filled spaces

102
Q

COPD induction & emergence concept

A

Longer induction & emergence r/t slower gas exchange

103
Q

High or low tidal volume in COPD patients?

A

Higher Vt supports increased gas exchange

104
Q

Capnograph phase 1

A

Anatomical dead space ventilation

105
Q

Capnograph phase 2

A

Dead space mixed w/ alveolar ventilation

106
Q

Capnograph phase 3

A

Alveolar ventilation (where ETCO2 measured)

107
Q

Capnograph phase 4

A

End of exhalation & start of inspiration

108
Q

Downsloping of phase III capnograph means what possible pathology?

A

Severe emphysema
-Alveolar destruction can cause rapid initial emptying of CO2

109
Q

Prolonged Phase II/III with widened alpha angle on capnograph. Resembles a “shark fin.”

A

Bronchospasm
Airway obstruction
COPD

110
Q

Cardiac oscillations during IV capnograph may indicate

A

-Hypovolemia
-Hypoventilation
-Each heartbeat ejects a small amount of CO2

111
Q

Curare cleft on capnography

A

Usually seen as rapid “hiccup/down spike” during phase III of capnograph.
- Patient desynchrony during mechanical ventilation & trying to breathe

112
Q

Prominent phase IV with terminal upswing on the capnograph may indicate

A

Obesity
Pregnancy
Poor compliance

113
Q

Capnograph does not return to baseline

A

Rebreathing effect

114
Q

Sudden drop in ETCO2 in capnograph

A

-Displaced ETT
-Decreased CO (arrhythmia, PE, etc.) = bc if blood is not pumping well to lungs, there is reduced delivery of CO2 to lungs & thus little gas exchange occurring & therefore a drastic decrease in exhaled CO2

115
Q

Why is PETCO2 usually less than PaCO2?

A

Dead space
*Alveolar : arterial gradient

116
Q

____________________ measures exhaled CO2 content & displays results graphically.

A

IR Spectroscopy

117
Q

Brief pathogenesis of Asthma & what it results in

A

Inflammation of the airway with non-specific hyperirritability of the tracheobronchial tree
**Result = airflow limitation

118
Q

Pulmonary function test (PFTs) for asthma

A

***Both decreased
-Decreased FEV1
-Decreased FEV1/fvc ratio
-FEV 25-75%
-Normal FEV = 4-5 L/sec

119
Q

What would an ABG & ECG show with asthma?

A

-Respiratory alkalosis
-ECG = ST changes, RV strain, RV deviation

120
Q

Sputum Eosinophilia with Curschmann spirals & Charcot-Leyden crystals is diagnostic of what respiratory disease?

A

Asthma

121
Q

Elevated peak pressures & increased PPV in asthma can cause…

A

Barotrauma, pneumothorax, lung hyperinflation, air trapping

122
Q

Alveolar distension in asthmatics causes this cascade…

A

Decrease in venous return
-With impaired ventilation –> increased PVR & RV afterload = leading to hemodynamic collapse

123
Q

Asthma preop anesthesia management pearls

A

-Review PFTs & asthma control = use of inhalers w/in last 6 mo
-If on corticosteroids –> give preop steroids = 100mg hydrocortisone q8h
-Consider atropine or glycopyrrolate for bronchodilation. Ketamine may be nice adjunct
-Anxiolysis important = friend
-Inhalers before surgery
-Quit smoking >8 weeks so cilia can return back to normal function

124
Q

What intraoperative meds should be avoided in asthmatics?

A

-Histamine releasing agents (thiopental, morphine, etc)
-ISO & DES d/t mild irritation
-Beta Blockers (esmolol/labetolol) r/t bronchoconstriction
-Toradol avoidance in ASA induced asthma patients
-Avoid H2 blockade d/t prolonged NMBAs

125
Q

Intraoperative asthma exacerbation anesthesia management

A

Deepen anesthetic
FiO2 100%
B2 agonist up to 10 puffs
IV or SQ epi for severe tx
Hydrocortisone 2-4 mg/kg
IV aminophylline if long term vent only

126
Q

Pulmonary HTN diagnostic pressures

A

PASP >30 mmHg
PMAP >20 mmHg

127
Q

Why might pulmonary HTN cause chest pain?

A

-Increase in RV myocardial O2 demand
-Decrease in coronary blood flow

128
Q

ECG changes & CXR findings with pulmonary HTN

A

RA hypertrophy = tall/peaked P-waves >2.5mm in anterior & inferior leads –> II, III, aVF = P-pulmonale

-RV hypertrophy

CXR = Dilated Pulmonary Artery

129
Q

Gold standard assessment/diagnostic of pulmonary HTN

A

**Cardiac cath + PA angiography
-Right-sided heart catheter w/ swanz

130
Q

What anesthetic agent in particular do you want to avoid with pulmonary HTN & why?

A

Avoid ketamine d/t it increasing pulmonary vascular resistance = worsening PAH
-If severe enough, can lead to RHF

131
Q

Cor Pulmonale definition

A

Pulmonary HTN w/ RV hypertrophy, dilation, & cardiac decompensation
-Sustained increase in PVR
-RV failure

Dx w/ right heart cath & pulm angio

132
Q

Cor Pulmonale signs & symptoms

A

***Right heart failure
-Cardiac heave or thrust & LSB
-S3 gallop d/t fluid overload
-S4 r/t RV hypertrophy
-Wide split S2
-Pulmonic +/- tricuspid regurg
-ECG = RA enlargement + displacement, RVH
-Can develop SVT, A-fib, ST, PAT
-CXR = pulmonary arteries enlarged +/- RVH
-Backflow of fluid = JVD + edema in those places + hepatomegaly

133
Q

Pulmonary Embolism

A

Collective term for entry of blood clots, fat, tumor cells, air, amniotic fluid, or foreign material into venous system

-90% from DVT

134
Q

Virchow’s Triad

A

Hypercoagulability + Vascular Damage + Circulatory Stasis

135
Q

Virchow’s factors of hypercoagulability

A

**Estrogen therapy, inflammation, dehydration
-Major surgery/trauma
-Malignancy, autoimmune condition, inherited thrombophilia
-Post-partum
-Infection & sepsis
-IBD

136
Q

Virchow’s factors of vascular damage

A

**Physical trauma, strain, injury,
**Microtrauma to vessel wall
-Indwelling catheter/heart valve
-Venepuncture
-Atherosclerosis
-Thrombophlebitis
-Cellulitis

137
Q

Virchow’s factors of circulatory stasis

A

** Bradycardia & hypotension
**Congenital venous anatomy abnormalities (May-Thurner & Paget-Schroetter syndrome)
-A-fib or LV dysfunction
-Venous obstruction d/t obesity, tumor, pregnancy
-Vericose veins

138
Q

Surgical procedures with greatest incidences of perioperative PE

A
  1. Hip fracture repair & THA
  2. Acute SCI
  3. Trauma
  4. TKA
  5. Thoracic
  6. General Surgery
139
Q

Patho of Pulmonary Embolus

A

Whether obstructive or neurohumoral (chemical), the cascade begins with pressure load. This increases wall tension & O2 demand with a decrease in RV coronary perfusion pressure (CPP) leading to ischemia, RV decompensation, and decreased RV output. RV volume increases d/t its inability to pump forward effectively, shifting the IV septum & restricting the pericardium leading to a decreased LV distensibility. LV preload drops which decreases CO & MAP further worsening RV coronary perfusion pressure.

140
Q

Mechanism of why/how a PE causes hypoxemia

A

Decreased CO & Increased dead space
-Increased PA pressure –> decreased HPV, transudate fluid = decreases FRCC & CC
-PLT & serotonin activation –> increases capillary permeability = decreases FRC & CC
-Serotonin causes bronchoconstriction = decreases FRC & CC & hypoventilation

141
Q

4 primary reasons of hypoxia in PE

A

-Decreased CO
-Decreased HPV
-Decreased FRC-CC
-Hypoventilation

142
Q

What is the most accurate/definitive diagnostic of PE

A

Helical CT scan
& TEE

143
Q

Acute intrinsic restrictive pulmonary disease

A

Edema, aspiration, ARDS

144
Q

Chronic intrinsic restrictive pulmonary diseases

A

Fibrosis, radiation, auto immune, O2 toxicity, sarcoidosis

145
Q

Chronic extrinsic restrictive pulmonary diseases

A

Flail chest, pneumo, atelectasis, effusion

146
Q

Pulmonary Edema Treatment

A

O2, PEEP, Vasodilators, Inotropes, Steroids, Diuretics
-Maybe morphine to decrease preload

147
Q

Mendelson’s syndrome

A

*Chemical pneumonitis
-Acid pH <2.5, highly particulate, large volume >25 mL

148
Q

Why might lidocaine be used in the treatment of aspiration?

A

Lidocaine inhibits neutrophil response

149
Q

ARDS causes damage to…

A

Alveolar capillary membrane
-release of cytokines & phospholipids from capillary endothelium

150
Q

ARDS & Anesthesia

A

-Use ICU vent if anesthesia machine cannot handle ventilation
-Caution barotrauma
-Hypovolemia –> foley for fluid status
-Invasive lines

151
Q

Bleomycin tx r/t interstitial fibrosis

A

-O2 & ABG monitor
-100% FiO2 for only 4 min prior to induction
-Low FiO2 AFTER intubation
-PEEP
-Judicial use of IV fluids
-May need postop vent
-Postop FiO2 down

152
Q

Sarcoidosis

A

-Decreased lung compliance
-Decreased diffusing capacity
-Reduced lung volumes
***Pulmonary involvement in 90%

153
Q

Flail chest

A

Multiple rib fractures
**Paradoxical movement at site of fracture
-Can have trauma BEHIND fractures (pulmonary contusions). Decreased Vt r/t pain –> thoracic epidural would be helpful. Maybe intercostal nerve blocks

154
Q

Communicated Pneumothorax

A

-Communicated w/ Atmosphere
-Lung collapses on inspiration & extends slightly with expiration
**Place occlusive tissue on

155
Q

Tension pneumo

A

Shifts trachea to opposite side
**16-18g needle decompression @ anterior mid-clavicular line

156
Q

Does general anesthesia contribute to atelectasis?

A

Yes. Use PEEP and recruitments
-30 cmH2O for 10 seconds

157
Q

What other conditions are often seen with Pectus Carinatum?

A

Heart defects = VSD, PDA, ASD, MV

158
Q

A cobb angle greater than ____________ in kyphoscoliosis will produce pulmonary symptoms

A

Cobb angle >60-70
-Reduced lung volumes & chest wall compliance

159
Q

Ankylosing spondylitis pearls

A

-Restrictive lung pattern
*****Limited cervical neck movement
-Affects c5-c7 the most

160
Q

The 4 M’s primarily for thoracic cancer treatment

A

-Mass effects
-Metabolic events = lambert-eaton syndrome, hypercalcemia, hyponatremia, cushing syndrome
-Metastases
-Medications

161
Q

Two factors of thoracic surgery that contribute to postop morbidity & mortality?

A

Respiratory = atelectasis, pneumonia, respiratory failure

-Cardiac complications = arrhythmia, ischemia

***Focus on preop assessment & risk stratification

162
Q

Single best test for lung mechanics in thoracic surgery

A

Predicted postoperative forced expiratory volume in 1 sec (ppoFEV1%)

**High risk <30%

163
Q

Diffusion Lung Capacity (DLCO)

A

Used to determine gas exchange capacity
*** <40% = higher pulmonary & cardiac risk

164
Q

Lung parenchymal function values

A

PaO2 >60
PaCO2 <45 mmHg

165
Q

Highest predictor of cardiopulmonary interaction

A

Stair climbing

-NOT most formal

166
Q

Most formal & gold standard of cardiopulmonary interaction

A

maximal O2 consumption (VO2)

167
Q

Fluid management in thoracic cases

A

Conservative. <500-1,000 mL

168
Q

In lateral position, where should A-line, pulse oximeter, and frequent pulse checks occur?

A

Dependent/down arm

169
Q

PEEP to dependent lung during tx of hypoxia in OLV will….

A

-Can cause shunt to non-dependent lung
-Can decrease CO

170
Q

Early ligation or clamp to nondependent pulmonary artery for tx of hypoxia during OLV will ….

A

Shunt blood from nondependent to the dependent, ventilated lung

171
Q

Which lung to give CPAP during tx of hypoxia under OLV?

A

CPAP to non-dependent (upright) lung
-Start at 2 cmH2O

172
Q

After back on 2 lung ventilation, important to do this with the DLT…

A

Dop bronchial (blue) cuff to decrease risk of bronchial necrosis

173
Q

Cryoablation for thoracic surgery can lead to …

A

postop thoracotomy pain syndrome

174
Q

Tumors of the mediastinum

A

Thymoma, thyroid mass, teratoma, lymphoma
***Can compress airways & vital cardiac structures

175
Q

Mediastinal mass can cause__________ at any time throughout anesthetic process

A

Airway collapse

176
Q

What position to induce patient for anesthesia who has a mediastinal mass?

A

Induce sitting upright

177
Q

Critical to perform preoperatively in patient with mediastinal mass

A

**Review CT scans, MRI, or any radiographic findings prior to any anesthesia or airway interventions

178
Q

Want to keep patient with mediastinal mass _____________________

A

Spontaneously ventilating

Respiratory Anesthesia (1 decks)

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