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ANES 477 Clinical Decisions > Thoracic > Flashcards

Thoracic Flashcards

1
Q

How long is an adult trachea?

A

11-13cm

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2
Q

At what spine does an adult trachea begin?

A

C6

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3
Q

At what angles do the R & L bronchi diverge from the trachea?

A

R 25, L 45

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4
Q

How many lobes does each lung have?

A

R - 3, L - 2

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5
Q

What is the lateral distance of the upper lobes from the carina?

A

R - 1-2.5cm, L 5cm

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6
Q

Which bronchiole is smaller, the one leading to the right middle or right lower?

A

right lower, is 40:60 diameter split

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7
Q

Which are the true ribs? the false ribs? the floating ribs?

A

true (connect to sternum directly) - 1-7; false (connect to sternum via cartilage or don’t connect at all) - 8-12; floating (don’t connect to sternum) 11-12

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8
Q

In one-lung ventilation, which is the dependent lung?

A

the lung being ventilated

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9
Q

What is the ideal patient position during OLV?

A

lateral with dependent lung on the bottom (so that blood flows to it)

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10
Q

What is a normal PaO2?

A

80-100mmHg

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11
Q

What types of airways are available for one-lung ventilation?

A

DLT, single lumen w/ bronchial blocker, single lumen bronchial tube

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12
Q

What size DLT should a patient have?

A

female: 35 Fr < 63” ht < 37 Fr
male: 37-39 Fr < 67” ht < 41 Fr

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13
Q

What is the standard depth (at the teeth) of a DLT?

A

29cm

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14
Q

What are three disadvantages of the single-lumen tube with bronchial blocker?

A
  • blocked lung collapses slowly
  • doesn’t allow suctioning or ventilation of isolated lung
  • catheter is easily dislodged
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15
Q

Which is the isolated lung?

A

the one not being ventilated

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16
Q

Which types of OLV tubes have the potential to cause the most trauma?

A

Carlen’s (with carinal hook)

17
Q

What is one major advantage of the DLT?

A

ability to ventilate and suction either lung

18
Q

Which types of OLV tubes can ventilate the isolated lung?

A

all except bronchial blocker

19
Q

Which OLV tubes have the best success rate of ventilating RUL?

A

Robertshaw and Carlens because they have a slit in the bronchial cuff

20
Q

What are absolute indications for OLV (3)?

A
  • isolation of spillage or contamination
  • bronchopleural fistula
  • unilateral bronchopulmonary lavage
21
Q

FEV1/FVC <__% is a high-risk post-op predictor.

A

50

22
Q

Diffusing capacity <__% is a high-risk post-op predictor.

A

50

23
Q

RV/TLC >__% is a high-risk post-op predictor.

A

50

24
Q

PaCO2 >__mmHg is a high-risk post-op predictor

A

45

25
Q

What does ppo FEV1 stand for?

A

prediction of post-op fractional expired volume in 1 second

26
Q

How is ppo FEV1 calculated?

A

pre-op FEV % x (1 - % functional tissue removed/100)

27
Q

What are the percent volumes of each lobe?

A

RUL 14%, RML 10%, RLL 29%, LUL 24%, LLL 24%

28
Q

What are is one reason why the bottom lung in lateral decubitus would have smaller tidal volumes?

A

chest wall is constricted by bean bag holding patient in place

29
Q

Under GA, why do tidal volumes decrease for both lungs?

A

with GA there is an increase in intra-abdominal pressure which decreases diaphragmatic movement

30
Q

In upright or supine position, the right lung receives what percent of TBF?

A

55%

31
Q

In lateral decubitus, the bottom lung receives what percent of TBF? Why?

A

60%; shunting (?)

32
Q

What nerves are most likely to be injured during thoracic surgery?

A

vagus, phrenic, recurrent laryngeal (positioning [lateral] - brachial plexus)

33
Q

HPV is triggered by what sensors? where?

A

O2 sensors in pulmonary artery smooth muscle cells

34
Q

What anesthetic agents decrease HPV?

A

inhalationals at >1 MAC, vasodilators (including propofol and etomidate)

35
Q

What notable anesthetic agents have to effect on HPV?

A

ketamine, morphine, fentanyl

36
Q

How should hypoxemia in OLV be treated?

A

100% O2; manual ventilation; ventilate at 40mmHg; CPAP 5-10cmH2O to collapsed lung; PEEP to ventilated lung; continuous O2 to collapsed lung; clamp pulm artery of collapsed lung

37
Q

Why is too much PEEP bad in OLV?

A

Increases shunting of blood to the collapsed lung

ANES 477 Clinical Decisions (8 decks)

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