Thoracic Procedures Flashcards
Pulmonary function high risk indicators?
- FVC 50%
- Diffusing capacity 45
What would FVC, FEV1, FEV1/FVC, and RV/TLC look like in a intrinsic restrictive patient?
- FVC = Decreased
- FEV1 = Normal
- FEV1/FVC = Normal
- RV/TLC = Normal
What would FVC, FEV1, FEV1/FVC, and RV/TLC look like in a extrinsic restrictive patient?
- FVC = Decreased
- FEV1 = Normal
- FEV1/FVC = Normal
- RV/TLC = Increased
What is the difference between Obstructive and restrictive lung diseases?
- Obstructive is difficulty exhaling
- Restrictive is difficulty fully expanding lungs with air
What would FVC, FEV1, FEV1/FVC, and RV/TLC look like in an obstructive lungs disease like asthma, bronchitis, or emphysema?
- FVC = Normal
- FEV1 = Decreased
- FEV1/FVC = Decreased
- RV/TLC = Increased
What is generally the presenting problem with patients with Pulmonary HTN, RVH, or Cor Pulmonale?
-Right heart failure
Right heart failure signs and symptoms
- Dependent edema
- Large, tender liver
- Ascites
- Dilated neck veins
What 3 things would appear in a CXR of pulmonary HTN?
- Pulmonary vessel dilation
- COPD
- RVH
What are the main LV dysfunction contributors?
- Hypoxia
- Hypercarbia
- Hypertension
- acidosis
- Alterations in intrathoracic pressure
- CAD
- Valve disease
- Ventricular Interdependence
What 4 things should be addressed in preop?
- Stop smoking
- Breathing exercises
- Bronchdilation
- Weight reduction
What meds can be used for bronchodilation?
- Aminophylline
- Cromolyn sodium
- Parasympatholytics
- Sympathomimetics
Thoracic surgery intraop goals
- Minimize anesthesia time
- Control secretions
- Prevent aspiration
- Bronchodilation
- Intermittent hyperinflation
Thoracic surgery postop goals
- Mobilize secretions
- Early intubation
- Cough and deep breathe
- Analgesia
Name 3 sympathomimetics
- Metaproterenol
- Albuterol
- Terbutaline
How does a sympathomimetic work?
-Beta agonist that increases cAMP = bronchodilation
Name 2 parasympatholytics
- Atropine
- Ipratropium vromide
How do parasympatholytics work?
-Decrease cGMP = inhibits bronchodilation
Name a phosphodiesterase inhibitor?
-Aminophylline
How do phosphodisterase inhibitors work?
-inhibit breakdown of cAMP
How do steroids work and name one.
- Reduce mucosal edema and suppress inflammation
- Beclomethasone
How does cromolyn sodium work?
-Mast cell stabilizer which prevents histamine release
When would you use digitalis?
- Left sided heart failure
- SVT or rapid ventricular response
When would prone position be used?
- Prevent flooding to tracheobronchial tree
- TB
- Pulmonary abcess
What is the standard thoracotomy position?
Lateral decubitis
How is ventilation and perfusion effected in the lateral decubitus position? And which happens first?
- Dependent lung is better perfused (first)
- Independent lung is better ventilated
What are the advantages of lateral decubitis?
- Complete access hemithorax
- Length of incision can be increased
- Patient easily tilted
- Safest for hilar
- Control of hilar vessels
Disadvantages of lateral decubitis
- Opposite hemithorax inaccessible
- V/Q mismatch
- Contamination of dependent lung
- Decreased FRC, airway closure, and atelectasis of dependent lung
How can you separate the lungs?
- Double lumen tube
- Univent ETT
- Bronchial blocker
3 reasons to separate the lungs?
- Prevent cross lung contamination
- Redistribute ventilation
- Unilateral bronchopulmonary levage
Indications to separate the lungs?
- Exposure for:
- -Thoracic aortic aneurysm
- -Lobectomy
- -Pneumonectomy
- -Esophageal resection
- -Subsegmental resection
Increased risk of death during thoracotomy?
- Cardiopulmonary disease
- Obesity
- Advanced age
- Tumor
- Pericardial involvement
- Pulmonary HTN
What should be avoided in GA and one lung ventilation?
- N2O
- Hypoxia
Steps when hypoxia on one lung ventilation?
- 100% O2
- ABG
- Check placement w/ fiber optic
- May need to reinflate lung
- CPAP to independent lung
- PEEP if CPAP fails
- Clamp pulmonary artery
Contraindications to DLT?
- Lesions along tube pathway
- Difficulty obtaining direct vision intubation
- Critically ill patient can’t tolerate apnea
- Full stomach
Things to worry about with bronchoscopy?
- Sharing airway w/ surgeon
- Arrhythmias
- Hypertension
- Hypoxemia
Rigid bronchoscopy tidbits.
- Glyco early to dry up secretions
- Topical
- Short acting drugs
- Light sedation
When is a fiberoptic bronch used?
-Eval of tracheobronchial tree deeper than rigid
Contraindications to bronchoscopy?
- Unstable CV
- Life threatening arrhythmias
- hypoxemia
Problems encountered during bronchoscopy?
- Coughing
- HTN
- Tachycardia
- Bleeding my require lung seperation
Indications for pneumonectomy
- Non-small cell lung CA
- Drug resistant TB
- Trauma
- Myobacterium
- Fungal infection
- Necrosis
What is eaton lambert syndrome?
- Muscle wasting
- May influence muscle relaxant choice
Chest tubes are clamped to prevent what?
-Mediastinal shifts
Ipsilateral mediastinal shift problems?
- Hypotension
- arrhythmias
- cardiac herniation
- Pulmonary edema
Contralateral mediastinal shift signs?
- Decreased lung function
- decreased venous return
