Thoracic Anesthesia

Question 1

What are some lung isolation techniques?

Answer 1

DLT, Bronchial Blocker, Endobracheal Tube

Question 2

What are the cases that you would ALWAYS need one lung ventilation?

Answer 2

Bronchopleural fistula, Bronchocutaneous fistula, intrapulmonary bleed, unilateral infection, giant unilateral bullae, & tracheobronchial disruption.

Question 3

What are contraindications for one lung ventilation?

Answer 3

patient refusal, endobroncheal lesion on one side, bronchial compression from aortic aneurysm, pulmonary artery compression from ant mediastinal mass

Question 4

What DLT is most commonly used and why?

Answer 4

Left sided DLT because the left side’s tracheobronchial tree anatomy makes it easier to place.

Question 5

What are the common sizes used for DLT?

Answer 5

Female: 35 (160cm) French
Male: 39 (170cm) French

Question 6

The depth when placing a DLT is determined by?

Answer 6

29 cm for female/male that is 170cm. For every 10cm increase/decrease in height, change depth by 1cm.

Question 7

How do you check to see if a DLT is placed correctly?

Answer 7

auscultations and fiberoptic bronchoscopy

Question 8

What is Hypoxic Pulmonary Vasoconstriction?

Answer 8

It’s initiated by alveolar hypoxia during one lung ventilation. The upper lung is not being ventilated now so it becomes hypoxic which increases vascular resistance leading to lower perfusion.

Question 9

What are the physiologic changes during one lung ventilation?

Answer 9

Ventilation best in nondependent areas (usually on top) b/c it’s not being compressed by the other lung
Perfusion best in dependent areas (usually on bottom) due to gravity. V/Q mismatch.
CO2 minimally effected.

Question 10

How do you treat hypoxemia during one lung ventilation?

Answer 10

• CPAP to nonventilated lung
• PEEP to ventilated lung
• Increase FiO2
• Intermittent OLV
• Clamp pulmonary artery of nonventilated lung (rare)

Question 11

What is dyspnea?

Answer 11

Dyspnea is an imbalance between the amount of ventilation required by the body and the patient’s ability to respond to this requirement

Question 12

What are the most common complications in thoracic anesthesia?

Answer 12

Respiratory, cardiac, and vascular.

Question 13

What are the minimal criteria for a pt to undergo thoracic anesthesia?

Answer 13

i. FEV1 > 2 liters
ii. FEV1/FVC (forced vital capacity) > 50%
iii. MVV (maximal voluntary ventilation: tests motor strength and motor reserve) > 50% predicted
iv. RV/TLC < 50%

Question 14

What does the pulmonary assessment consist of?

Answer 14

Respiratory mechanics, gas exchange, and cardiorespiratory interaction

Question 15

What ppoFEV1 would suggest a pt could tolerate extubation in the OR?

Answer 15

ppoFEV1 > 40%

Question 16

What are some coexisting diseases for thoracic anesthesia?

Answer 16

pulmonary complications, cardiac complications, arrhythmias, and renal complications