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Fall25 AdvPrin C > Thoracic Anesthesia Pt. 2 (Exam III) > Flashcards

Thoracic Anesthesia Pt. 2 (Exam III) Flashcards

1
Q

What is the smallest ETT size necessary for an ION bronchoscopy?

A

9.0

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2
Q

Why is room air induction preferred for ion bronchoscopies?

A

Prevention of absorption atelectasis

No more than 0.8 FiO₂

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3
Q

Is paralysis required for ion bronchoscopies?

A

yes

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4
Q

What type of ventilator settings should be utilized to maintain lung inflation during ion bronchscopies?

A
  • High VT
  • High Peep
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5
Q

What does Bronchoscopic LVRS stand for?

A

Lung Volume Reduction Surgery

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6
Q

What is Bronchoscopic LVRS?

A

Endobronchial stents placed to provide a collapse of certain lung areas (functionally a lobectomy).

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7
Q

What is bronchoscopic LVRS used for?

A
  • Improvement of V/Q mismatch
  • Improve quality of life for severe COPD patients.
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8
Q

What structures are at risk for damage during a mediastinoscopy?

A
  • Heart
  • Great vessels
  • Trachea
  • Esophagus
  • Thymus
  • Lymph nodes
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9
Q

What is the most common indication for mediastinoscopy?

A

Mediastinal Lymphadenopathy

  • Infection
  • Sarcoidosis
  • Lymphomas
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10
Q

What disease can cause granulomas that lead to lung scarring & fibrosis?

A

Sarcoidosis

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11
Q

What is the only absolute contraindication to mediastinoscopy?

A

Previous Mediastinoscopy (scar tissue formation & distortion)

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12
Q

What are the relative contraindications to mediastinoscopy?

A
  • Limited cervical ROM
  • Thoracic aortic aneurysm
  • Severe tracheal displacement
  • Hx of chest radiation therapy
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13
Q

What division of the mediastinum is the conduit division?

A
  • Superior (conduit = head to chest)
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14
Q

What division of the mediastinum is the protective division?

A
  • Anterior (protective - fatty/connective)
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15
Q

What are the four divisions of the Mediastinum?

A
  • Superior
  • Anterior
  • Middle
  • Posterior
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16
Q

Name the structures of the four below categories in the Superior division of the mediastinum:

  • Organs:
  • Arteries:
  • Veins:
  • Nerves
A
  • Organs: Thymus, trachea, esophagus
  • Arteries: Aortic Arch, Left common carotid, left subclavian
  • Veins: SVC, brachiocephalic vein
  • Nerves: Vagus, recurrent laryngeals, phrenic
17
Q

Name the structures of the four below categories in the Anterior division of the mediastinum:

  • Organs:
  • Arteries:
  • Veins:
  • Nerves
A
  • Organs: Thymus
  • Arteries: Internal thoracic branches
  • Veins: internal thoracic branches, parasternal lymph nodes
  • Nerves: none
18
Q

Name the structures of the four below categories in the Middle division of the mediastinum:

  • Organs:
  • Arteries:
  • Veins:
  • Nerves
A
  • Organs: Heart, great vessels, trachea, bronchi
  • Arteries: ascending aorta, pulmonary trunk
  • Veins: SVC, Pulmonary veins
  • Nerves: Phrenic, Vagus, symphathetics
19
Q

Name the structures of the four below categories in the Posterior division of the mediastinum:

  • Organs:
  • Arteries:
  • Veins:
  • Nerves
A
  • Organs: Esophagus
  • Arteries: Descending thoracic aorta
  • Veins: Azygos & hemoazygos
  • Nerves: Vagus, Splanchnic, Sympathetic
20
Q

What are common complications of a mediastinoscopy?

A
  • Pneumothorax
  • Mediastinal hemorrhage
  • VAE
  • Recurrent Laryngeal nerve damage
  • Airway structure damage
  • CO obstruction
21
Q

Where should an art line be placed for a mediastinoscopy? Why?

A

Right radial (in order to monitor for brachiocephalic compression)

22
Q

What ventilator pressure should be monitored more closely during a mediastinoscopy?

A

PIP (Peak Inspiratory Pressure)

Monitor for airway structure compromise.

23
Q

What position is a patient induced in for a mediastinoscopy?

A

Sitting position

24
Q

What two options are available for airway blocks?

A
  • Topicalization
  • Glossopharyngeal Block
25
Q

How would one topicalize the airway?

A
  • Cetacaine spray
  • 4% Lidocaine “lollipop”
26
Q

What local anesthetic is injected for a glossopharyngeal block?
Where is it injected?

A

2mL of 2% Lidocaine

  • Tongue displaced medially & injection at anterior tonsillar pillar
27
Q

Where does the glossopharyngeal nerve provide sensory innervation?

A
  • Posterior ⅓ of tongue
  • Vallecula
  • Epiglottis
  • Pharynx
28
Q

What areas would be be blocked with a superior laryngeal nerve block?

A
  • Pharynx
  • Glottis
  • Aryepiglottic fold
29
Q

How is a superior laryngeal nerve block performed?

A
  • Walk needle off cornu of hyoid
  • 2mL of 2% Lidocaine
30
Q

Which block provides anesthesia to the trachea & vocal cords?

A

Transtracheal block

31
Q

How is a transtracheal block performed?

A
  • Locate cricothyroid membrane
  • Aspirate for air
  • Inject 4mL of 2% lidocaine slightly caudad
32
Q

What are the two cancerous indications for esophagectomy?

A
  • Squamous cell carcinoma
  • Adenocarcinoma
33
Q

What are the two most common causes of esophageal squamous cell carcinoma?

A
  • Excessive Alcohol consumption
  • Long term smoking
34
Q

Why does frequent metastasis often occur with esophageal cancer?

A

Lots of lymph nodes around esophagus

35
Q

Esphagectomy Chart

A
36
Q

What are the most common complications of esophagectomy?

A

Pulmonary

  • Pneumonia
  • ARDS
  • Empyema
37
Q

What less common complications occur with esophagectomies?

A
  • Anastomosis leaks (early)
  • Dumping syndrome
  • Esophageal stricture
  • Aspiration risk for life.
38
Q

What lifelong risk is conferred by esophagectomy?

A

Aspiration Risk

Fall25 AdvPrin C (11 decks)

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