Thoracic Anesthesia

Question 1

Name 4 lung isolation techniques

Answer 1

• double lumen tubes
• univent tube
• bronchial blockers
• endobroncheal tube

Question 2

Name some absolute indications for endobronchial intubation.

Answer 2

• bronchopleural fistula
• bronchocutaneous fistula
• intrapulmonary bleed
• uilateral infection
• giant unilateral bullae
• tracheobronchial disruption

Question 3

What are some relative indications for endobronchial intubation?

Answer 3

• pneumonectomy
• lobar resection
• esophageal surgery
• video-assisted thoracic surgery
• minimally invasive cardiac surgery
• broncheal lavage

Question 4

Name the two types of double lumen tubes. Describe the one big difference between them.

Answer 4

• Carlen’s tube vs. Robertshaw tube

- Carlen’s has a carina hook whereas Robertshaw does not

Question 5

Which main stem bronchus comes off at a more acute angle?

Answer 5

Right main stem

Question 6

Which sided DLT do we almost always use?

Answer 6

Left-sided DLT

Question 7

The cuff of the tubes is of the_____ pressure and _____ volume type.

Answer 7

low pressure and high volume

Question 8

What sizes of DLT do we usually use for adult females? For adult males?

Answer 8

Females: 35 or 37Fr
Males: 39 or 41 Fr

Question 9

What are two ways to establish correct DLT placement?

Answer 9

auscultation and fiberoptic bronchoscopy

Question 10

Name the basic criteria for selecting a proper DLT.

Answer 10

how tall the patient is and what gender

Question 11

For a male or female 170cm tall, you would insert the DLT to a depth of ___ cm. For every ___ cm change in height, change depth of insertion by ___ cm.

Answer 11

29 cm; 10 cm; 1 cm

Question 12

After placing a left-sided DLT properly and inflating both cuffs, if we ventilate through the bronchial lumen, we should hear breath sounds over ____ lungs only. If we ventilate through the tracheal lumen, we should hear breaths sounds over ____ lungs only.

Answer 12

Left; right

Question 13

What is the smallest DLT size?

Answer 13

28 Fr

Question 14

What is the gold standard for one lung ventilation?

Answer 14

Double lumen tubes

Question 15

What are some physiologic changes during one lung ventilation?

Answer 15

• ventilation is best in nondependent areas
• perfusion is best in dependent areas (gravity)
• alveolar hypoxia initiate HPV
• CO2 exchange minimally effected

Question 16

HPV decreases blood flow by what percent?

Answer 16

50%

Question 17

HPV is inhibited by what?

Answer 17

volatile agents, vasodilators (NTG, SNP), peripheral vasoconstrictors, hypocarbia

Question 18

HPV is affected by ketamine, opioids and benzodiazephines.

Answer 18

False

Question 19

What are some common causes of hypoxemia during OLV?

Answer 19

double lumen malposition
kinked tube
secretion
pneumothorax
bronchospasm
low FiO2
low cardiac output
hypoventilation

Question 20

What are some ways to prevent hypoxemia during OLV?

Answer 20

apply CPAP to non-ventilated lung
apply PEEP to ventilated lung
intermittent OLV
clamp pulmonary artery of non-ventilated lung

Question 21

What is dyspnea?

Answer 21

sensation of not being able to take enough volume in, feeling of not being able to catch a breath

Question 22

When doing a pulmonary assessment, which three components do we look at?

Answer 22

• respiratory mechanics: how well pts can move their muscles and diaphragm, their motor strength
• gas exchange: diffusion abnormalities, perfusion difficulties
• cardiorespiratory interaction

Question 23

What does MVV stand for and what does it mean?

Answer 23

Maximal Voluntary Ventilation. It indicates an optimal well-integrated airway, cardiac, neuromuscular, and CNS status.

Question 24

What is the most useful test for pulmonary gas exchange?

Answer 24

Diffusion capacity for Carbon Monoxide