Thoracic Anesthesia Pt. 2 (Exam III) Flashcards
What is the smallest ETT size necessary for an ION bronchoscopy?
9.0
Why is room air induction preferred for ion bronchoscopies?
Prevention of absorption atelectasis
No more than 0.8 FiO₂
Is paralysis required for ion bronchoscopies?
yes
What type of ventilator settings should be utilized to maintain lung inflation during ion bronchscopies?
- High VT
- High Peep
What does Bronchoscopic LVRS stand for?
Lung Volume Reduction Surgery
What is Bronchoscopic LVRS?
Endobronchial stents placed to provide a collapse of certain lung areas (functionally a lobectomy).
What is bronchoscopic LVRS used for?
- Improvement of V/Q mismatch
- Improve quality of life for severe COPD patients.
What structures are at risk for damage during a mediastinoscopy?
- Heart
- Great vessels
- Trachea
- Esophagus
- Thymus
- Lymph nodes
What is the most common indication for mediastinoscopy?
Mediastinal Lymphadenopathy
- Infection
- Sarcoidosis
- Lymphomas
What disease can cause granulomas that lead to lung scarring & fibrosis?
Sarcoidosis
What is the only absolute contraindication to mediastinoscopy?
Previous Mediastinoscopy (scar tissue formation & distortion)
What are the relative contraindications to mediastinoscopy?
- Limited cervical ROM
- Thoracic aortic aneurysm
- Severe tracheal displacement
- Hx of chest radiation therapy
What division of the mediastinum is the conduit division?
- Superior (conduit = head to chest)
What division of the mediastinum is the protective division?
- Anterior (protective - fatty/connective)
What are the four divisions of the Mediastinum?
- Superior
- Anterior
- Middle
- Posterior
Name the structures of the four below categories in the Superior division of the mediastinum:
- Organs:
- Arteries:
- Veins:
- Nerves
- Organs: Thymus, trachea, esophagus
- Arteries: Aortic Arch, Left common carotid, left subclavian
- Veins: SVC, brachiocephalic vein
- Nerves: Vagus, recurrent laryngeals, phrenic
Name the structures of the four below categories in the Anterior division of the mediastinum:
- Organs:
- Arteries:
- Veins:
- Nerves
- Organs: Thymus
- Arteries: Internal thoracic branches
- Veins: internal thoracic branches, parasternal lymph nodes
- Nerves: none
Name the structures of the four below categories in the Middle division of the mediastinum:
- Organs:
- Arteries:
- Veins:
- Nerves
- Organs: Heart, great vessels, trachea, bronchi
- Arteries: ascending aorta, pulmonary trunk
- Veins: SVC, Pulmonary veins
- Nerves: Phrenic, Vagus, symphathetics
Name the structures of the four below categories in the Posterior division of the mediastinum:
- Organs:
- Arteries:
- Veins:
- Nerves
- Organs: Esophagus
- Arteries: Descending thoracic aorta
- Veins: Azygos & hemoazygos
- Nerves: Vagus, Splanchnic, Sympathetic
What are common complications of a mediastinoscopy?
- Pneumothorax
- Mediastinal hemorrhage
- VAE
- Recurrent Laryngeal nerve damage
- Airway structure damage
- CO obstruction
Where should an art line be placed for a mediastinoscopy? Why?
Right radial (in order to monitor for brachiocephalic compression)
What ventilator pressure should be monitored more closely during a mediastinoscopy?
PIP (Peak Inspiratory Pressure)
Monitor for airway structure compromise.
What position is a patient induced in for a mediastinoscopy?
Sitting position
What two options are available for airway blocks?
- Topicalization
- Glossopharyngeal Block
How would one topicalize the airway?
- Cetacaine spray
- 4% Lidocaine “lollipop”
What local anesthetic is injected for a glossopharyngeal block?
Where is it injected?
2mL of 2% Lidocaine
- Tongue displaced medially & injection at anterior tonsillar pillar
Where does the glossopharyngeal nerve provide sensory innervation?
- Posterior ⅓ of tongue
- Vallecula
- Epiglottis
- Pharynx
What areas would be be blocked with a superior laryngeal nerve block?
- Pharynx
- Glottis
- Aryepiglottic fold
How is a superior laryngeal nerve block performed?
- Walk needle off cornu of hyoid
- 2mL of 2% Lidocaine
Which block provides anesthesia to the trachea & vocal cords?
Transtracheal block
How is a transtracheal block performed?
- Locate cricothyroid membrane
- Aspirate for air
- Inject 4mL of 2% lidocaine slightly caudad
What are the two cancerous indications for esophagectomy?
- Squamous cell carcinoma
- Adenocarcinoma
What are the two most common causes of esophageal squamous cell carcinoma?
- Excessive Alcohol consumption
- Long term smoking
Why does frequent metastasis often occur with esophageal cancer?
Lots of lymph nodes around esophagus
Esphagectomy Chart
What are the most common complications of esophagectomy?
Pulmonary
- Pneumonia
- ARDS
- Empyema
What less common complications occur with esophagectomies?
- Anastomosis leaks (early)
- Dumping syndrome
- Esophageal stricture
- Aspiration risk for life.
What lifelong risk is conferred by esophagectomy?
Aspiration Risk
