Thoracic Anesthesia Flashcards
Name 4 lung isolation techniques
- double lumen tubes
- univent tube
- bronchial blockers
- endobroncheal tube
Name some absolute indications for endobronchial intubation.
- bronchopleural fistula
- bronchocutaneous fistula
- intrapulmonary bleed
- uilateral infection
- giant unilateral bullae
- tracheobronchial disruption
What are some relative indications for endobronchial intubation?
- pneumonectomy
- lobar resection
- esophageal surgery
- video-assisted thoracic surgery
- minimally invasive cardiac surgery
- broncheal lavage
Name the two types of double lumen tubes. Describe the one big difference between them.
- Carlen’s tube vs. Robertshaw tube
- Carlen’s has a carina hook whereas Robertshaw does not
Which main stem bronchus comes off at a more acute angle?
Right main stem
Which sided DLT do we almost always use?
Left-sided DLT
The cuff of the tubes is of the_____ pressure and _____ volume type.
low pressure and high volume
What sizes of DLT do we usually use for adult females? For adult males?
Females: 35 or 37Fr
Males: 39 or 41 Fr
What are two ways to establish correct DLT placement?
auscultation and fiberoptic bronchoscopy
Name the basic criteria for selecting a proper DLT.
how tall the patient is and what gender
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.
29 cm; 10 cm; 1 cm
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.
Left; right
What is the smallest DLT size?
28 Fr
What is the gold standard for one lung ventilation?
Double lumen tubes
What are some physiologic changes during one lung ventilation?
- ventilation is best in nondependent areas
- perfusion is best in dependent areas (gravity)
- alveolar hypoxia initiate HPV
- CO2 exchange minimally effected
HPV decreases blood flow by what percent?
50%
HPV is inhibited by what?
volatile agents, vasodilators (NTG, SNP), peripheral vasoconstrictors, hypocarbia
HPV is affected by ketamine, opioids and benzodiazephines.
False
What are some common causes of hypoxemia during OLV?
double lumen malposition kinked tube secretion pneumothorax bronchospasm low FiO2 low cardiac output hypoventilation
What are some ways to prevent hypoxemia during OLV?
apply CPAP to non-ventilated lung
apply PEEP to ventilated lung
intermittent OLV
clamp pulmonary artery of non-ventilated lung
What is dyspnea?
sensation of not being able to take enough volume in, feeling of not being able to catch a breath
When doing a pulmonary assessment, which three components do we look at?
- respiratory mechanics: how well pts can move their muscles and diaphragm, their motor strength
- gas exchange: diffusion abnormalities, perfusion difficulties
- cardiorespiratory interaction
What does MVV stand for and what does it mean?
Maximal Voluntary Ventilation. It indicates an optimal well-integrated airway, cardiac, neuromuscular, and CNS status.
What is the most useful test for pulmonary gas exchange?
Diffusion capacity for Carbon Monoxide
