Thoracic sx (final) Endoscopy procedures ppt. Newby Flashcards
I have nothing bad to say about Boyd and his arms he is leaving us : ( sad face.... I hope it's not windy his last day.. or he won't be able to wave goodbye to us : (
what are some basic disease states that may require thoracic sx
- Lung Tumors
- esophageal Disease
- mediastinal Tumors
- Infection
- Bronchiectsis
- Thoracic aneurysms
Thoracic sx
so what are 2 main endoscopy procedures?
- Bronchoscopy
- esophagoscopy
Thoracic sx:
what are 2 mediastinal procedures
- mediastinoscopy
- Thymectomy (not an endoscopic procedure)
Monitoring for endoscopic sx:
what monitors do you need nood endoscopy procedures
- all standard monitors
- Radial A-line
Monitoring for endoscopic sx:
what do you want to consider then doing an A-line for these procedures?
- Left vs Right A-line
- lateral decubitus position A-line in dependent arm (AKA the arm on the bottom)
- Mediastinoscopy- A-line in Left arm (b/c innominante artery)
(so if you are confused on lateral decubitus here is how I remember it- Decubitus- comes from the latin word “decumber” ( i am pretty sure lol) meaning lying down or to lie down. thus right lateral decubitus means “to lie down on right side”)
Endoscopy: Anesthesia
how is flexible bronchoscopy performed?
MAC
or
GETA
Endoscopy: Anesthesia
how are Rigid Bronchoscopy performed
GETA
Endoscopy: Anesthesia
what are some concerns with Rigid Bronchoscopy prodecures (for you the anesthesia provider)
- Hypercapnea
- Hypoxemia
- Air leaks
Endoscopy: Anesthesia
what are ways to ventilate a pt whle a rigid bronchoscopy is being performed?
- Anesthesia machine vs Jet ventilation
- Side arm ventilation port
- Sanders Bronchoscopes ( ventiri effect w/ jet vent)
Endoscopy Procedure:
what are complications?
- Facial, dental, laryngeal injury
- Airway rupture
- pneumothorax
- hemorrhage
- Airway obstruction
Endoscopy Procedure:
what things may cause airway obstructions?
- Blood
- FB
- Edema
Endoscopy Procedure:
what are some anesthesia considerations
- Small ETT vd Double lumen tube
- Laser tube and Laser precautions
- Short acting hypnotics
- Inhaled vs TIVA anesthesia
- Short acting Narcs
- Short acting Muscular relaxants
- Local anesthesia (post-op)
Endoscopy Procedure:
if using a SCh gtt or multiple doses od SCh what may occur? and what should you do?
- Bradycardia (treat if needed)
- Phase II block ( do nothing who gives a shit it’s cool)
What type of approach are these
- Cervical
- Anterior
Mediastinal Procedures:
what do we discover performing an upright and Supine PFT’s? and why do we do this?
- If PFT normal upright then decreased when laying down then we know they have a restrictive disease
- and we can identify AIRWAY risk
Mediastinal Procedures:
so after performing Upright and Supine PFTs we discover the pt has a poor supine PFT… besides an airway risk why do we give a shit? basically what airway risk can occur and how will we provoke that? how can you treat it?
- if you have a pt with a poor supine PFT and give NMBD and VAA you may not be able to ventilate them.
- This is due to the compression of airway do to changes in pressures and muscle loss in the intercostals
- Treatment is performed by sitting up and restoring spontaneous ventilation and normal intrathoracic pressures
Mediastinal Procedures:
so if a pt does have poor Supine PFTs (which most will thus the reason they are probally having the sx) what drugs to we want to use of induction and why? (r/t NMBD)
- with or without SCh (if using just use a little)
- there is really no need for SCh to intubate, we only use it to gain a better view for double lumen tube placement
Mediastinal Procedures:
what are the complications?
- # 1- rupture/Laceration to major vessels
- # 2 Pneumo (Hemo)- thorax
- intermittent occlusion of Right innominate artery (thats why A-line is on the Left)
- Tracheal collaps
- Tension pneumomediastinum
- mediastinitis
- chylothorax
Mediastinal Procedures:
what 3 main procedures require a median sternotomy?
- thymectomy
- mediastinal masses
- Bilateral Pulmonary resecrtion
Mediastinal Procedures:
what is the treatment of choice for myasthenia Gravis?
Thymectomy
(just for knowledge- sternal incision or cervical appraoach)
Myasthenia Gravis:
is an autoimmune disease that effect the __________ ACh receptors?
post junctional
Myasthenia Gravis:
is more prevalent in what sex
females
1:20,000
Myasthenia Gravis:
10% of MG pts develop what?
thymomas
(from ACh-antibodies)
Myasthenia Gravis:
is characterized by what? (What are the bascic S/S)
- Occular, pharyngeal, and skeletal- muscle weakness
Myasthenia Gravis:
treatment
- anticholinesterases
- corticosteroids
- immuniosupressents
- plasmapheresis
- thymectomy
Myasthenia Gravis: Anesthetic Considerations:
what about home meds?
hold anticholinesterase meds day of sx (continue up until that day)
Myasthenia Gravis: Anesthetic Considerations:
muscle relaxants?
(+++) NDMR and (–) DMR
- effects based on therapy
Myasthenia Gravis:
what is an associated disease that involes the PRE-junctional decreased ACh release?
Eaton-Lambert Syndrome
Myasthenia Gravis:
is there inprovement with Anticholinesterases with Eaton-Lambert Syndrome
nope
Myasthenia Gravis: Eaton-Lambert Syndrome
what is the underyling problem?
SCCa of the lung
Myasthenia Gravis: Eaton-Lambert Syndrome
which muscle are most affected with this d/o?
peripheral muscles and pelvis
Myasthenia Gravis: Eaton-Lambert Syndrome
symptoms improves with _______ and weakens after
Exertion
Myasthenia Gravis: Eaton-Lambert Syndrome
muscle relaxation choice for the D/O?
(+++) NDMR and DMR
Mediastinal Masses: Anesthesia Considerations
what do you want to consider prior to putting these pt’s asleep? (specicif to repiratory system)
- Degree of functional impairment
- Orthopnea
- Supine and Upright PFTs
Mediastinal Masses: Anesthesia Considerations
other considerations
- Specific Ct report/reexamination
- Close communication with sx
Mediastinal Masses: Anesthesia Considerations
what is DYNAMIC AIRWAY OBSTRUCTION?
- position/muscle tension dependent
- Fine with upright/ spont vent; DEAD with supine and reaxed
- Cant ventilate even with properly placed ETT
Mediastinal Masses: Anesthesia Considerations
what is treatment for DYNAMIC AIRWAY OBSTRUCTION?
- rigid Bronch (emergent)
- Positin change
- Sponteous ventilation
