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Cardiothoracic Princ. III > 1: Lightning Bolts & Bullseyes #1 > Flashcards

1: Lightning Bolts & Bullseyes #1 Flashcards

all of the starred/highlighted content for exam 1 (62 cards)

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1
Q

considerations for squamous cell caricinoma

A

central lesions (predominantly)
often with endobronchial tumor
mass effects: obstruction, cavitation

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2
Q

considerations for adenocarcinoma

A

peripheral lesions
extrapulmonary invasion common
most pancoast tumors
growth hormone, corticotropin
hypertrophic osteoarthropathy

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3
Q

considerations for large cell carcinoma

A

large, cavitating peripheral tumors
similar to adenocarcinoma

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4
Q

considerations for small cell carcinoma

A

central lesions (predominantly)
surgery usually not indicated
paraneoplastic syndromes
Lambert-Eaton syndrome*
fast growth rate
early metastases

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5
Q

Lambert-Eaton syndrome

A
  • impaired release of acetylcholine from the terminals; lower limb weakness
  • sensitive to non-depolarizers and respond poorly to anticholinesterase reversal agents
  • may improve after surgery
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6
Q

considerations for carcinoid tumors

A

proximal, endobronchial
bronchial obstruction with distal pneumonia
highly vascular
benign (predominantly)
no association with smoking
5 year survival > 90%
carcinoid syndrome (rarely)

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7
Q

carcinoid*

A

severe hypotension may need to use specific antagonists: octreotide or somatostatin

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8
Q

care of the patient on Bleomycin

A

low FiO2 d/t pulmonary toxicity (avoid hyperoxia)

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9
Q

care of the patient on Cisplatin

A

NSAIDs contraindicated d/t increased creatinine

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10
Q

4 M’s of Anesthetic considerations in lung cancer patients

A
  1. Mass effects
  2. Metabolic effects
  3. Metastases
  4. Medications
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11
Q

mass effects of lung cancer

A

obstructive pneumonia, LUNG ABSCESS, SVC syndrome, tracheobronchial distortion, pancoast syndrome, recurrent laryngeal nerve or phrenic nerve paresis, chest wall or mediastinal excision

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12
Q

metabolic effects of lung cancer

A

Lambert-Eaton syndrome, HYPERCALCEMIA, HYPONATREMIA, cushing’s

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13
Q

metastases effects of lung cancer

A

particularly to bone, brain, liver, and adrenal

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14
Q

medication considerations for lung cancer patients

A

Bleomycin, mitomycin: pulmonary toxicity
Doxorubicin: cardiac toxicity
Cisplatin: renal toxicity

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15
Q

of the lung cancer considerations, which are the most detrimental?

A

mass effects

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16
Q

Preop Lung Function: what is the 80-40-15 rule?

A

FEV1 > 80% (no testing needed)
PPO FEV1 DLCO < 40% (increased risk, exercise test)
VO2 Max < 15 mL/kg/min (increased risk)

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17
Q

most valid test for respiratory mechanical function

A

FEV1

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18
Q

most valid test for lung parenchymal function

A

DLCO

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19
Q

most valid test for caridopulmonary interaction

A

maximal oxygen consumption (VO2)

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20
Q

ABG CO2 > 45 mm Hg

A

indicator of poor ventilatory function

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21
Q

SaO2 < 90%

A

preop hypoxemia

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22
Q

albumin < 3.6 and BUN > 22

A

important predictor of pulmonary complications

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23
Q

renal function and nephrotoxic drugs

A

methotrexate & cisplatin

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24
Q

what is a more reliable indicator of poor outcomes with thoracic surgery?

A

desaturation with exercise

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25
findings consistent with pulmonary disease (echo)
RIGHT ATRIAL CHAMBER ENLARGEMENT i.e. disease, pulmonary hypertension
26
arterial line in the . . . (mediastinoscopy) ox
Aline = RIGHT to detect compression of innominate artery BP cuff = left Pulse ox = right to detect compression of innominate artery
27
aline position for thoracotomy
in DEPENDENT arm to monitor possible AXILLA artery compression
28
pros/advantages of DLT
EASY TO PLACE repositioning rarely needed bronchoscopy to isolated lung suction to isolated lung CPAP EASILY ADDED can alternate OLV to either lung easily placement possible without bronchoscopy best device for absolute lung isolation
29
pros/advantages of bronchial blockers
size selection rarely an issue easily added to regular ETT allows ventilation during placement easier placement in 1) difficult airways and 2) children postop two-lung ventilation by withdrawing blocker selective lobar lung isolation possible CPAP to isolated lung possible
30
Cons/disadvantages of DLTs
size selection more difficult difficult for difficult airways/abnormal tracheas not optimal for postop ventilation potential laryngeal trauma potential bronchial trauma
31
cons/disadvantages of BBs
more time needed for positioning repositioning more often bronchoscope essential for positioning limited right lung isolation d/t RUL anatomy bronchoscopy to isolated lung impossible minimal suction to isolated lung difficult to alternate OLV to either lung
32
DLT FM < 160 cm
35
33
DLT FM > 160 cm
37
34
DLT M > 170 cm
41
35
DLT M < 170 cm
39
36
FM < 152 cm
examine bronchial diameter on CT scan consider 32-Fr DLT shorter patients (<155 cm) height is not a good predictor
37
M < 160 cm
consider 37 Fr DLT
38
DLT insertion: resistance?
There should be NO resistance with placement but slight resistance when you reach the bifurcation.
39
indications for DLT
descending thoracic aortic aneurysm left lung transplant left-sided tracheobronchial disruption left-sided pneumonectomy
40
what can cause malposition of the DLT?
overinflation surgical manipulation head extension
41
how to diagnose malposition?
fiberoptic
42
s/s of malposition?
hypoxemia
43
DLT in optimal position but lung deflation is not achieved
suction cath to lung collapse (make sure to remove)
44
other problems with DLT
airway trauma DLT too big rupture of bronchus or aneurysm unexpected air leak subQ emphysema airway bleed protrusion of cuff into filed tension PTX in dependent lung during OLV
45
benefits of bronchial blockers (again)
challenging airway previous oral or neck surgery pediatrics
46
complications of BBs
lack of seal within bronchus distal wire stapled into the lobectomy
47
when is a patient considered high risk
advanced age poor general health status COPD BMI > 30 kg/m2 low FEV1 low predicted postop FEV1
48
interpleural space
potential space between the parietal pleura of the internal chest wall and the visceral pleura covering the lung
49
intrapleural pressure
NEGATIVE/SUBATMOSPHERIC lungs recoil inward and the chest wall recoils outward
50
inward and outward forces are equal at ?
FUNCTIONAL RESIDUAL CAPACITY
51
intrapleural during tidal breathing
always negative
52
intrapleural pressure becomes negative during ____ and positive during _____
inspiration; expiration
53
vasalva maneuver
intrapleural pressure becomes positive during a forced expiration or during expiratory effort against a closed glottis
54
zone 1 (west)
dead space region is ventilated but not perfused
55
zone 2 (west)
waterfall arterial pressure exceeds alveolar flow is solely dependent on arterial flow
56
zone 3 (west)
swan ganz pulm arterial and venous pressures exceed alveolar pressure; dependent portion of the lung
57
zone 4 (west)
pulmonary edema (pahological) interstitial fluid compresses the vessels and occlude their flow
58
zone 3 is ...
dependent better ventilation better perfusion lower V/Q ratio less negative intrapleural pressure
59
west zones describe ______ in the lungs
PERFUSION
60
which portions of the lung receive greater amount of blood flow?
dependent due to gravity, vessel recruitment, and distensibility results in optimal gas exchange
61
R-->L shunt
Blood pumped by the Rt heart passes to the Lt heart without being oxygenated Reasons: anatomic defect, blood passing through the lungs does not come in contact with O2 in the alveoli-intrapulmonary ie ARDS
62
L --> R shunt
Blood is pumped from the Lt heart back to the right usually in neonate Ductus arteriosus or foramen ovale

Cardiothoracic Princ. III (8 decks)

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