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Advanced Principles C > Thoracic Anesthesia Pt. 1 (Exam III) > Flashcards

Thoracic Anesthesia Pt. 1 (Exam III) Flashcards

1
Q

How many total lung segments are there?

A

42

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2
Q

How many segments make up the right lung?

A

22

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3
Q

How many segments make up the left lung?

A

20

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4
Q

What is FEV₁?

A

Forced expiratory volume in 1 second after a full inspiration

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5
Q

What is a normal Predicted FEV₁?

A

80 - 120%

High percentage = healthier lungs

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6
Q

What are good predicted FEV₁ values associated with?

A

Good post-op outcomes

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7
Q

What is the formula for postoperative FEV₁?

A

Postop FEV₁% = Preop FEV₁% x (1 - % of lung tissue removed/100)

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8
Q

Given the following:

Preop FEV₁ = 70%
25% of lung tissue removed.

What is the expected Post FEV₁?

A

Post FEV₁ = 70 x [(1 - (25/100)]

Post FEV₁ = 52.5%

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9
Q

Given the following:

Preop FEV₁ = 110%
33% of lung tissue removed.

What is the expected Post FEV₁?

A

Post FEV₁ = 110 x [1 - (33/100)]

73.7%

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10
Q

Postoperative FEV₁ of ____ or less have an increased risk of pulmonary complications.

Postoperative FEV₁ of ____ or less have a very high risk.

A

40%

30%

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11
Q

V/Q:

V = ?
Q = ?

A

V = Ventilation
Q = Perfusion

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12
Q

What PaO₂ and PCO₂ preoperative values are associated with poor postoperative outcomes?

A

PaO₂ < 60 mmHg
PCO₂ > 45 mmHg

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13
Q

What is the most useful test for determing gas exchange capacity?

A

DLCO (Diffusing Lung Capacity for Carbon Monoxide)

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14
Q

How is a DLCO test performed?

A
  • Small amount of CO is inhaled with tracer gas (helium or methane)
  • CO high affinity for Hgb
  • Exhaled gas analyzed
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15
Q

A DLCO test will correlate with what?

A

Total functioning surface area of alveolar/capillary interface.

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16
Q

Is DLCO or FEV₁ affected by chemotherapy?

A

DLCO is affected by chemotherapeutics

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17
Q

What would a high amount of exhaled CO from a DLCO test indicate?

A

Poor gas exchange

Due to CO not being picked up by the bloodstream at the alveoli.

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18
Q

What is the absolute minimum DLCO and FEV₁ needed for thoracic surgery?

A

20%

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19
Q

What is the ideal V/Q ratio?
What is more typical?

A

Ideal = 1.0
Typical = 0.8

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20
Q

Review West Zones

A
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21
Q

Pulmonary arterial pressure ( Pa) is always greater than pulmonary ____ pressure.

A

venous ( Pv)

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22
Q

The absolute pressure of Pa and Pv is greater in the ________ portion of the lung due to hydrostatic gradients.

A

dependent

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23
Q

Blood flow is most dependent on what?

A

gravity

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24
Q

The base of the lung receives how much more blood pressure relative to the apex of the lung? (in an upright person)

A

20 mmHg increase

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25
Q

What lung zone is depicted by 1 in the figure below?
What pressures would be exhibited by this lung?

A
  • Zone 1
  • PA > Pa > Pv
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26
Q

How much blood flow is seen in a Zone 1 lung? Who has Zone 1 lungs?

A
  • Very little to no blood flow. Zone 1 lungs are a pathologic condition.
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27
Q

What lung zone is depicted by 2 in the figure below?
What pressures would be exhibited by this lung?

A
  • Zone 2
  • Pa > PA > Pv
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28
Q

What lung zone is depicted by 3 in the figure below?
What pressures would be exhibited by this lung?

A
  • Zone 3
  • Pa > Pv > PA
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29
Q

What lung zone exhibits pulsatile blood flow?
What lung zone exhibits non-pulsatile continuous blood flow?
What is the reasoning for the difference?

A
  • Pulsatile = Zone 2
  • Continuous = Zone 3
  • Gravity: ↑ pressure = ↑ perfusion
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30
Q

What lung zone is depicted by 1 in the figure below?

A

Zone 4

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31
Q

Which lung zone is defined by the following:

  1. Alveoli maximally distended
  2. Complete compression of capillaries
  3. Ventilation but no blood flow (dead space)
A

Zone 1 ( PA > Pa > Pv )

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32
Q

Which lung zone is defined by the following:

  1. Restricted venous flow
  2. Arterial flow exceeds PA
  3. Ventilation but no blood flow (dead space)
A

Zone 2

( Pa > PA > Pv )

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33
Q

Where is lung zone 2 located in relation to the heart?

A

3cm above the heart

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34
Q

Which lung zone is defined by the following:

  1. Unrestricted blood flow
  2. More compliant alveoli & greater ventilation.
  3. Vasculature more distended
A

Zone 3
( Pa > Pv > PA )

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35
Q

In which lung zone will blood flow vary with the cardiac cycle and respirations?

A

Lung Zone 2

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36
Q

Which lung zone’s blood flow is unaffected by the cardiac cycle and respirations?

A

Zone 3

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37
Q

Zone 1 is _____ in healthy patients.

A

absent

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38
Q

In a normal healthy lung Pa will be ______ than PA.

A

greater → Pa > PA

39
Q

What two common things will produce zone 1 ventilation?

A
  • Positive Pressure Ventilation = ↑ alveolar pressure.
  • Hemorrhage/shock/hypovolemia = drop in arterial pressure.
40
Q

Why does blood flow in pulses in Zone 2 of the lungs?

A

Systole = Pa > PA
Diastole = PA > Pa

41
Q

For accurate measurement of PCWP, the PA catheter must be place in which pulmonary zone?

42
Q

Which zone has the greatest perfusion and highest hydrostatic pressures?

43
Q

Which pulmonary function test is used to determine if lung disease is obstructive, restrictive, or normal?

A

FEV₁/FVC Ratio

44
Q

What is a normal FEV₁/FVC ratio in healthy adults?

45
Q

What are the most common disease processes exhibiting obstructive patterns?

A
  • COPD (Bronchitis & Emphysema)
  • Asthma
  • Cystic Fibrosis
46
Q

What is the most common comorbidity in the thoracic surgical population?

47
Q

What condition is characterized by the following:

  • Decreased area for gas exchange
  • Air-trapping
  • Hyperinflation of lung tissue
48
Q

What environmental factors other than smoking have been implicated in lung cancer?

A
  • Asbestos
  • Radon
  • Diesel gas
  • Heavy metals
49
Q

Do the below factors describe SCLC or Non-SCLC?

  • Less aggressive
  • Affects smokers & non-smokers
  • More common
  • Better prognosis
A

Non-Small Cell Lung Cancer

50
Q

Do the below factors describe SCLC or Non-SCLC?

  • Fast-growing
  • Aggessive
  • Associated with smoking
  • Starts in bronchi
  • Metastasizes
A

Small Cell Lung Cancer

51
Q

What lung cancer is most sensitive (susceptible) to radiation therapy?

52
Q

What are the sub-categories of Lung resection? (partial lobe removal)

A
  • Sleeve
  • Wedge
  • Segment
53
Q

What is pleurodesis?

A

Obliteration of pleural space to prevent recurrence of fluid, pus, or blood build up.

54
Q

What is the most common thoracotomy approach?

A

Anterolateral

55
Q

Differentiate lung separation vs lung isolation?

A

Separation = Adequate lung deflation

Isolation = Complete lung deflation

56
Q

What is DLT sizing for women?

57
Q

What is DLT sizing for men?

58
Q

What direction should a left-sided DLT be turned once at the vocal cords?

A

To the left

59
Q

What should tidal volume be set to on an isolated lung?

A

4 - 6 mL/kg

(increase rate to maintain normocapnia)

60
Q

100% O₂ must be avoided in chemo patients who have received _______.

61
Q

What are the cons of hyperoxemia from excessive FiO₂?

A
  • Absorption atelectasis
  • Coronary vasoconstriction
62
Q

What type of shunt occurs from one lung ventilation?

A

Right to Left Shunt

Venous blood returning to heart has not been oxygenated. Causes relative hypoxemia.

63
Q

How is One-Lung ventilation shunt lessened during thoracic surgery?

A
  • Surgical manipulation (obstructs blood flow to non-ventilated lung).
  • Lateral Positioning (increased perfusion to dependent, ventilated lung)
  • HPV reduces blood flow in operative lung
64
Q

Describe Hypoxic Pulmonary Vasoconstriction.

A

Alveolar hypoxia results in vasconstriction of pulmonary vasculature (↑PVR).

65
Q

Due to HPV, blood preferentially moves to ______ ventilated areas.

66
Q

What happens if atelectasis occurs in the dependent (non-operative) lung?

A

Atelectasis → HPV → Dependent lung vasoconstriction → blood shunted to non-ventilated, operative lung.

67
Q

HPV is desired in the ________ lung.

A

operative

Not wanted in the non-operative, dependent lung.

68
Q

Which drug class attenuates HPV? How so?

A

All VAA’s via vasodilation

69
Q

What VAA dosage will start to attenuate HPV?

70
Q

HPV being decreased will cause an ______ shunt and ________ oxygenation.

A

Decreased shunt and worsening oxygenation

71
Q

What factors will attenuate/decrease the effects of HPV?

A
  • VAA > 1 MAC
  • Alkalosis
  • Hypocapnia
  • Hypothermia
  • Hemodilution
  • Vasodilators
72
Q

What are the most common complications associated with One-Lung Ventilation?

A
  • DLT Malposition
  • Airway ETT Trauma
  • Bronchospasm
  • Hypoventilation
  • Hypoxemia
73
Q

What can occur if 100 FiO₂ is administered to a patient receiving bleomycin?

A

Free Radical oxidative damage & pulmonary toxicity

74
Q

How is persistent hypoxemia associated with OLV treated?

A
  • Resume two lung ventilation
  • Surgeon ligation of pulmonary artery
75
Q

What is the best predictor of difficult DLT placement?

76
Q

What is the gold standard for cardiopulmonary fitness?

A

V̇O₂ Max

77
Q

What is the average healthy male V̇O₂ max?

A

30 - 40 mL/kg/min

78
Q

What is the average healthy female V̇O₂ max?

A

27 - 32 mL/kg/min

79
Q

There is an increased risk for thoracic surgery if a patient’s V̇O₂ max is less than ________.

A

15 mL/kg/min

80
Q

There is much less risk during thoracic surgery if a patient’s V̇O₂ max is greater than _______.

A

20 mL/kg/min

81
Q

Complications associated with smoking are reduced as soon as __ weeks after quitting smoking.

82
Q

________ concentrations decrease just 12 hours after quitting smoking.

A

Carboxyhemoglobin

83
Q

What endocrine disorder can result from SCLC? Why?

A

Cushing’s due to SCLC causing increased cortisol production

84
Q

Other than Cushing’s disease, what disorder is associated with SCLC?

A

Lambert Eaton Myasthenic Syndrome

85
Q

How long must thoracic surgery be delayed after bare metal coronary stenting?

A

4 - 6 weeks

86
Q

How long must thoracic surgery be delayed after drug-eluting coronary stent placement?

87
Q

What is the most common concurrent disease associated with thoracic surgery?

88
Q

What cardiac disease is common in COPD patients?

A

RV failure

89
Q

What is the most common EKG complication associated with thoracic surgery?

A

Atrial Fibrillation

(Due to ↑ PVR & SNS stimulation)

90
Q

Where should a CVL be placed on a thoracotomy patient?

A

Ipsilateral Non-operative side

91
Q

What VAA should be avoided in thoracic surgery?

92
Q

What type of nerve injury is common with thoracic surgeries?

A

Brachial Plexus injuries

93
Q

How is Acute Lung Injury best avoided?

A
  • Avoid fluid overload
  • Avoid hyperinflation
94
Q

What typically causes acute lung injury?

A
  • Hypervolemia
  • Excessively high ventilatory pressures

Advanced Principles C (11 decks)

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