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DNURS 827 Advanced Physiology/Pathophysiology for Anesthesia I > Final Exam Review COPY > Flashcards

Final Exam Review COPY Flashcards

1
Q

Adult larynx anatomic location

A

Anterior to C3-C6

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2
Q

At birth larynx anatomic location

A

C3-C4

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3
Q

Larynx lies between ___ and ___

A

Pharynx and trachea

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4
Q

Normal A-O extension

A

35 degrees

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5
Q

Mallampati Classification

A

Pt sitting, neck extended, mouth fully opened, tongue protruded, no phonation

MP Classes 1-4

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6
Q

MP Class 1

A

Full view of uvula and tonsillar pillars, soft palate

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7
Q

MP Class 2

A

Partial view of uvula or uvular base, partial view of tonsils, soft palate

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8
Q

MP Class 3

A

Soft palate only

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9
Q

MP Class 4

A

Hard palate only

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10
Q

Sphenopalatine ganglion—middle division of CN ___ and innervates what 4 structures?

A

Middle division of CN V

  • Nasal mucosa
  • Superior pharynx
  • Uvula
  • Tonsils
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11
Q

Glossopharyngeal nerve innervation

A

CN IX

  • Posterior 1/3 of tongue
  • Pharyngeal, tonsillar nerves
  • Oral pharynx
  • Supraglottic region
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12
Q

Internal branch of superior laryngeal nerve

A

CN X

  • Mucus membrane above the vocal cords
  • Glottis
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13
Q

Recurrent laryngeal nerve

A

CN X

-Trachea below the vocal cords

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14
Q

Superior laryngeal nerve is a branch of what cranial nerve?

A

Vagus nerve (CN X)

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15
Q

The superior laryngeal nerve divides into what two nerves?

A
  • Internal superior laryngeal nerve

- External superior laryngeal nerve

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16
Q

Internal SLN

A
  • Provides sensation to supraglottic and ventricle compartment
  • Stimulation causes laryngospasm!
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17
Q

Stimulation of internal SLN causes ___

A

LARYNGOSPASM

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18
Q

External SLN provides ___ innervation to what muscle?

A

Motor innervation to cricothyroid muscle

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19
Q

Recurrent laryngeal nerve is a branch of what cranial nerve?

A

Vagus nerve (CN X)

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20
Q

Left RLN passes @ ___

A

Aortic arch

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21
Q

Recurrent laryngeal nerve provides sensory innervation to ___

A

Infraglottis

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22
Q

Recurrent laryngeal nerve provides motor innervation to all of the larynx except for the ___ muscle

A

Cricothyroid muscle

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23
Q

Stimulation of the recurrent laryngeal nerve causes ___

A

Abduction of vocal cords

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24
Q

Damage to the recurrent laryngeal nerve causes ___

A

Vocal cord adduction

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25
Q

What is the trachea?

A

Flexible cylindrical tube supported by 20-25 C-shaped cartilages

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26
Q

Diameter of the trachea

A

18-20 mm diameter

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27
Q

Length of trachea

A

12.5-18 cm length

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28
Q

Trachea extends from ___ to ___

A

C6 to T5

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29
Q

Where does the trachea divide into 2 bronchi?

A

At carina (level T5-T7); 25 cm from teeth

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30
Q

Inspiration is the ___ phase of breathing cycle

A

Active phase

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31
Q

What nerve transmits motor stimulation to diaphragm?

A

Phrenic nerve—C3, C4, C5

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32
Q

What nerves send signals to the external intercostal muscles?

A

Intercostal nerves (T1-T11)

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33
Q

The act of inhaling is ___

A

Negative-pressure ventilation

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34
Q

Transpulmonary pressure is the pressure difference between ___ and ___

A

Alveolar pressure and pleural pressure on outside of lungs

Alveoli tend to collapse together while the pleural pressure attempts to pull outward

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35
Q

What is recoil pressure?

A

The elastic forces which tend to collapse the lung during respiration

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36
Q

4 volumes of spirometry

A
  • Tidal volume (TV)
  • Inspiratory reserve volume (IRV)
  • Expiratory reserve volume (ERV)
  • Residual volume (RV)
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37
Q

Tidal volume (TV)

A

Amount of inspired air with a normal breath; amounts to about 500 ml in the avg adult male

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38
Q

Inspiratory reserve volume (IRV)

A

Extra volume of air that can be inspired over and above the normal tidal volume when the person inspires with full force; usually equals 3000 ml

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39
Q

Expiratory reserve volume (ERV)

A

Maximum extra volume of air that can be expired by forceful expiration after the end of a normal tidal expiration; about 1100 ml

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40
Q

Residual volume (RV)

A

Volume of air remaining in the lungs after the most forceful expiration; about 1200 ml

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41
Q

4 capacities of spirometry

A
  • Inspiratory capacity (IC)
  • Functional residual capacity (FRC)
  • Vital capacity (VC)
  • Total lung capacity (TLC)
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42
Q

Inspiratory capacity (IC) =

A

TV + IRV

The amount of air a person can breathe in, beginning at the normal expiratory level and distending the lungs to the maximum amount ~3500 ml

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43
Q

Functional residual capacity (FRC) =

A

ERV + RV

The amount of air that remains in the lungs at the end of normal expiration ~2300 ml

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44
Q

Vital capacity (VC) =

A

TV + IRV + ERV

The maximum amount of air a person can expel from the lungs after first filling the lungs to their maximum extent and then expiring to the maximum extent ~4600 ml

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45
Q

Total lung capacity (TLC) =

A

VC + RV
TV + IRV + ERV + RV

Max volume to which the lungs can be expanded with the greatest possible effort ~5800 ml

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46
Q

IC =

A

IRV + TV

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47
Q

FRC =

A

ERV + RV

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48
Q

VC =

A

IRV + ERV + TV

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49
Q

TLC =

A

IRV + TV + ERV + RV

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50
Q

TV ~

A

~500 ml

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51
Q

IRV ~

A

~3000 ml

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52
Q

ERV ~

A

~1100 ml

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53
Q

RV ~

A

~1200 ml

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54
Q

IC ~

A

~3500 ml

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55
Q

FRC ~

A

~2300 ml

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56
Q

VC ~

A

~4600 ml

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57
Q

TLC ~

A

~5800 ml

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58
Q

Spirometry cannot measure ___

A

Residual volume (RV)

Thus FRC and TLC cannot be determined using spirometry alone

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59
Q

FRC and TLC can be determined by ___, ___, and ___

A
  • Helium dilution
  • Nitrogen washout
  • Body plethysmography
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60
Q

What are 3 main functions of surfactant?

A
  • Lowers surface tension of alveoli and lung—increases compliance of lung; reduces work of breathing
  • Promotes stability of alveoli—alveoli have tendency to collapse; surfactant reduces forces causing atelectasis
  • Prevents transudation of fluid into alveoli—reduces surface hydrostatic pressure effects; prevents surface tension forces from drawing fluid into alveoli from capillary
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61
Q

What type of cells secrete surfactant?

A

Type II pneumocyte

Very important in neonates—maturation occurs at 24 weeks gestation

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62
Q

What forces air out of alveoli?

A

Elastic force caused by water tension attempts to force air out of alveoli

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63
Q

Poiseuille’s Law—reducing the radius by 16% will ___ the resistance

A

Double

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64
Q

Poiseuille’s Law—reducing the radius by 50% will increase resistance ___

A

16-fold (2^4)

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65
Q

If you double the radius, you reduce the resistance ___

A

16-fold (2^4)

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66
Q

Systemic circulation = ___ pressure, ___ flow, ___ resistance

A

High pressure, low flow, high resistance

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67
Q

Pulmonary circulation = ___ pressure, ___ flow, ___ resistance

A

Low pressure, high flow, low resistance

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68
Q

RA pressure

A

2-3 mm Hg

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69
Q

RV pressure

A

25 mm Hg

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70
Q

LA pressure

A

5-8 mm Hg

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71
Q

LV pressure

A

120 mm Hg

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72
Q

Mean pulmonary artery pressure

A

14-15 mm Hg

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73
Q

Mean systemic artery pressure

A

90-100 mm Hg (120/80)

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74
Q

Mean pulmonary capillary pressure

A

10-10.5 mm Hg

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75
Q

Mean systemic capillary pressure

A

20 mm Hg

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76
Q

What is recruitment?

A

Opening of previously closed vessels

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77
Q

What is distention?

A

Increase in caliber of vessels

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78
Q

What is the CHIEF mechanism for fall in pulmonary vascular resistance (PVR)?

A

Recruitment

However, both recruitment and distention are two mechanisms that decrease PVR

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79
Q

Increased CO ___ pulmonary vascular pressures but ___ pulmonary vascular resistance

A

Increases pulmonary vascular pressures but decreases pulmonary vascular resistance (occurs during periods of stress and increased tissue oxygen demand)

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80
Q

___% of alveolar surface area is covered by capillary bed

A

70-80%

Total capillary surface area almost equals alveolar surface area

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81
Q

Capillary volume increases by ___

A

Recruitment—opening closed segments

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82
Q

What is the normal capillary volume at rest?

A

70 ml (1 ml/kg body weight)

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83
Q

What is the maximal capillary anatomical volume?

A

200 ml

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84
Q

Distance RBCs have to travel through capillary network is ___

A

Small (600 to 800 micrometers)

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85
Q

Capillary network blood volume = ___ stroke volume

A

RV

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86
Q

Total blood volume from main pulmonary artery to left atrium is ___ ccs

A

500

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87
Q

Lung is ___% blood by weight

A

40-50%; this volume fraction > than any other organ

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88
Q

What is the capacitance reservoir for the left atrium?

A

The pulmonary vasculature—can act as a reservoir and alter its volume from 50 to 200% of resting volume

Can store blood in the lungs so that the LV doesn’t run dry as it pumps out to the systemic circulation

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89
Q

Inspired air O2/CO2 concentrations

A

PO2 150 mm Hg

PCO2 0 mm Hg

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90
Q

RBC/alveolar O2/CO2 concentrations

A 
PO2 = 100 mm Hg
PCO2 = 40 mm Hg
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91
Q

Deoxygenated blood O2/CO2 concentrations

A 
PO2 = 40 mm Hg
PCO2 = 46 mm Hg
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92
Q

Lung Zone 1

A

alveolar flow > pulmonary artery pressure > pulmonary vein pressure

very negligible blood flow through this area of the lung; can ventilate it all day long, but it’s not doing any gas exchange

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93
Q

Lung Zone 2

A

pulmonary artery pressure > alveolar pressure > pulmonary vein pressure

might get intermittent flow/exchange through zone 2 with changes in systolic/diastolic pressure during inhalation/exhalation; not a lot of flow/exchange going on here

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94
Q

Lung Zone 3

A

pulmonary artery pressure > pulmonary vein pressure > alveolar pressure

maximizes both blood flow and gas exchange because you have uninterrupted alveolar interfaces

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95
Q

Blood vessels are more distended at the ___ of the lung

A

Base

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96
Q

___ resistance to flow in the base of the lung

A

Decreased

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97
Q

___ (higher/lower) blood flow at the base of the lung

A

Higher

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98
Q

Higher ___ pressures in apex of lung than capillary pressures

A

Higher alveolar pressures; causes decreased perfusion in apex of lung

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99
Q

What are 3 ways to expand zone 1?

A
  • Decreased pulmonary artery pressure (i.e.: shock, hypovolemia)
  • Increased alveolar pressure (i.e.: PEEP)
  • Occlusion of blood vessels (i.e.: pulmonary embolism)
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100
Q

What are 2 ways to reduce zone 1?

A
  • Increased pulmonary artery pressure (i.e.: infusion of fluid or blood)
  • Reduced hydrostatic effect (i.e.: change patient position; standing to supine)
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101
Q

V/Q ratio is ___ in the upper lung

A

High

Because you have ventilation, but no perfusion

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102
Q

V/Q ratio is ___ in the lower lung

A

Low

Because you have good ventilation & perfusion in the bases of the lungs

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103
Q

What are 4 things that cause vasoconstriction of the pulmonary vasculature?

A
  • Reduced PaO2
  • Increased PCO2
  • Thromboxane A2
  • Histamine
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104
Q

What are 3 things that cause vasodilation of the pulmonary vasculature?

A
  • Increased PaO2
  • Prostacyclin
  • Nitric oxide
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105
Q

High CO2 =

A

Vasoconstriction

Why we hyperventilate neurosurgery patients…because low CO2 = vasodilation

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106
Q

Thromboxane A2 is a ___

A

Potent vasoconstrictor

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107
Q

Thromboxane A2 is produced during…

A

Produced during acute lung tissue damage by
macrophage, leukocytes, and endothelial cells

Effect localized to injured region because half-time of thromboxane inactivation is only seconds

Body’s way of protecting itself when the lung is injured

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108
Q

Prostacyclin is a ___

A

Potent vasodilator

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109
Q

Prostacyclin inhibits ___

A

Platelet activation

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110
Q

Nitric oxide is a ___

A

Epithelial vasodilator

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111
Q

Nitric oxide has a ___ effect

A

Strictly localized effect (only works where it is produced)

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112
Q

Nitric oxide is produced from ___

A

L-arginine

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113
Q

How does nitric oxide cause vasodilation?

A

Nitric oxide activates guanylyl cyclase, which produces cyclic GMP…cyclic GMP causes smooth muscle relaxation

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114
Q

Nitric oxide is delivered via ___

A

Inhalation technique

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115
Q

Nitric oxide is very ___ at high concentrations

A

Toxic

116
Q

Nitric oxide binds ___ to hemoglobin

A

Irreversibly

117
Q

Nitric oxide binds to hemoglobin ___ x’s greater than oxygen

A

200,000x’s greater

118
Q

Alveolar hypoxia produces ___

A

Hypoxic pulmonary vasoconstriction (HPV)

119
Q

HPV is a ___ response

A

Localized response of pulmonary arterioles

120
Q

HPV is caused by ___ and enhanced by ___ and ____

A

Hypoxia; enhanced by hypercapnia and acidosis

121
Q

HPV is a mechanism of balancing ___ ratio

A

V/Q

122
Q

HPV causes a shift of flow to ___

A

Better ventilated pulmonary regions

123
Q

Normal alveolar PO2 is ___

A

100 mm Hg

124
Q

Normal alveolar PCO2 is ___

A

40 mm Hg

125
Q

Alveolar PCO2 ___ in proportion to CO2 excretion

A

Increases

126
Q

As alveolar ventilation increases, PCO2 ___

A

Decreases (inverse relationship; O2 has direct relationship with alveolar ventilation)

127
Q

Normal CO2 production at rest is ___

A

200 ml/min

128
Q

Expired air is a combination of ___ air and ___ air

A

Dead space air and alveolar air

First portion of expired air = dead space air; consists of humidified air

Second portion of expired air = mixture of both dead space and alveolar air

129
Q

Alveolar air is expired at the end of ___

A

Exhalation

130
Q

What 4 factors affect diffusion? (according to Fick’s Law)

A
  • Cross sectional area of membrane
  • Partial pressure differences
  • Gas coefficient
  • Tissue thickness

Increase in:
-Cross sectional area
-Partial pressure difference (concentration gradient)
-Gas coefficient
INCREASE rate of diffusion; all are directly related to rate of diffusion

Tissue thickness is inversely related to rate of diffusion (thicker tissue = slower rate of diffusion)

131
Q

V/Q is normal when…

A

Alveolar ventilation and blood flow are both normal

132
Q

V/Q = zero

A

Ventilation = zero but perfusion is present (i.e.: complete airway obstruction)

133
Q

V/Q = infinity

A

If ventilation is present but there is no perfusion (i.e.: pulmonary artery obstruction)

134
Q

If V/Q ratio is zero or infinity, there is ___

A

No exchange of gases

135
Q

Physiologic shunt—V/Q is ___

A

Below normal

136
Q

Shunt =

A

Perfusion but no ventilation…blood is being shunted from pulmonary artery to pulmonary vein without participating in gas exchange

137
Q

Shunted blood is not ___

A

Oxygenated

138
Q

The greater the physiologic shunt, the greater the…

A

Amount of blood that fails to be oxygenated in the lungs

139
Q

Physiologic dead space—V/Q is ___

A

Greater than normal

140
Q

Dead space =

A

Ventilation but no perfusion…more available oxygen in alveoli than can be transported away by flowing blood

141
Q

Physiologic dead space includes ___ and ___

A
  • Wasted ventilation

- Anatomical dead space

142
Q

When physiologic dead space is great, much of the work of breathing is wasted effort because ___

A

Ventilated air does not reach blood

143
Q

SaO2 100%, PaO2 ___

A

100+

144
Q

SaO2 95%, PaO2 ___

A

75

145
Q

SaO2 90%, PaO2 ___

A

60

146
Q

SaO2 75%, PaO2 ___

A

40 (mixed venous blood in pulmonary artery)

147
Q

SaO2 60%, PaO2 ___

A

30

148
Q

SaO2 50%, PaO2 ___

A

27

149
Q

Very rough rule—PaO2 40, 50, 60 for sat ___, ___, ___

A

70, 80, 90

150
Q

Hemoglobin-oxygen equilibrium curve is affected in two ways:

A
  • Shift in position (left or right)

- Change in shape

151
Q

What indicates a greater interference with O2 transport—a change in position or shape?

A

Change in shape

152
Q

Change in shape of the HbO2 equilibrium curve is d/t change in ___

A

Hemoglobin

153
Q

Right shift of Hb-O2 dissociation curve—Hb has ___ affinity for O2, ___ O2, saturation will be ___ for a given PO2

A

Hb has less affinity for O2, releases O2, saturation will be less for a given PO2

154
Q

Left shift of Hb-O2 dissociation curve—Hb has ___ affinity for O2, ___ O2, saturation will be ___ for a given PO2

A

Hb has higher affinity for O2, binds O2, saturation will be higher for a given PO2

155
Q

4 causes of right shift:

A
  • Increased CO2
  • Increased temp
  • Decreased pH/increased H+
  • Increased 2,3 DPG
156
Q

3 causes of left shift:

A
  • Increased pH
  • Decreased temp
  • Decreased 2,3 DPG
157
Q

What is the Bohr effect?

A

Shift to the right d/t increase H+

158
Q

What has the greatest effect on the Hb-O2 dissociation curve?

A

A change in shape (so a change in hemoglobin) has the greatest effect on the curve than does any shift change (right or left)

159
Q

CaO2 =

A

O2 content in the blood…the sum of O2 carried on Hb and dissolved in plasma

160
Q

Formula for CaO2 =

A

(SaO2 x Hb x 1.31) + (PO2 x 0.003)

161
Q

1.31 =

A

ML of oxygen bound to one gram of hemoglobin

162
Q

0.003 =

A

O2 dissolved in 100 ml plasma…very small amount of oxygen dissolved in plasma

163
Q

Most CO2 is transported as ___

A

Bicarbonate (HCO3-)

164
Q

DRG or VRG controls respiration?

A

DRG

165
Q

What two cranial nerves deliver sensory information to the DRG?

A
  • Glossopharyngeal (CN IX)

- Vagus (CN X)

166
Q

DRG receives signals from what 3 sources?

A
  • Peripheral chemoreceptors
  • Baroreceptors
  • Lung receptors
167
Q

VRG is ___ during normal respiration

A

Inactive; only becomes active during exercise

168
Q

What is the chemosensitive area of the brainstem?

A

Highly sensitive area on ventral medulla surface; contains central chemoreceptors

169
Q

Chemosensitive area of brainstem is responsive to changes in ___ or ___

A

Blood PCO2 or H+ ion concentration

170
Q

Effect of CO2 on respiratory center activity

A

Increased CO2 = increased respiratory center activity

171
Q

CO2 has potent direct effect via ___ on the chemosensitive area

A

H+

172
Q

CO2 is highly permeable to blood-brain barrier, so blood and brain concentrations are ___

A

Equal

173
Q

How does CO2 form H+ ions?

A

CO2 + water —> carbonic acid, dissociates into H+ and bicarbonate ions in medulla/CSF

Released H+ ions in brain stimulate respiratory center activity

174
Q

CO2 diffuses ___ faster than oxygen does

A

20x’s faster

175
Q

What has greater effect on alveolar ventilation—change in PCO2 or change in pH?

A

PCO2

176
Q

Ventilation is greatly increased with blood PCO2 above ___

A

35 mm Hg—steep part of curve

177
Q

Chemoreceptors are located in ___ and ___

A

Carotid and aorta

178
Q

Peripheral chemoreceptors are stimulated by ___

A

Hypoxemia

179
Q

Where are the carotid bodies located?

A

Bifurcations in common carotid

180
Q

Carotid bodies innervation to DRG

A

CN IX (glossopharyngeal)

181
Q

Where are the aortic bodies located?

A

Aortic arch

182
Q

Aortic bodies innervation to DRG

A

CN X (vagus)

183
Q

Central chemoreceptors are located in the ___

A

Chemosensitive area of brainstem

184
Q

Peripheral chemoreceptors are located in ___ and ___

A

Carotid and aortic bodies

185
Q

Stimulation of chemoreceptors is caused by ___

A

Decreased arterial oxygen content

186
Q

Ventilation doubles when PaO2 falls below ___

A

60 mm Hg

187
Q

High risk PFT results—FEV1 < ___

A

FEV1 < 2L

188
Q

High risk PFT results—FEV1/FVC < ___

A

FEV1/FVC < 0.5

189
Q

High risk PFT results—VC < ___ in adult; VC < ___ in child

A

VC < 15 cc/kg in adult; VC < 10 cc/kg in child

190
Q

High risk PFT results—VC < ___

A

40 to 50% of predicted

191
Q

Intubation criteria—mechanics: RR > ___, VC < ___, NIF ___

A

RR > 35

VC < 15 cc/kg adult or < 10 cc/kg child

NIF less negative than -20 cm H2O

192
Q

Intubation criteria—PaO2 < ___ on FiO2 40%

A

PaO2 < 70 mm Hg on FiO2 40%

193
Q

Intubation criteria—PaCO2 > ___

A

PaCO2 > 55 (except in chronic hypercarbia)

194
Q

Intubation criteria—Vd/Vt > ___

A

Vd/Vt > 0.6 (remember, normal dead space is 30%)

195
Q

Intubation criteria—clinical status (6)

A
  • Airway burn
  • Chemical burn
  • Epiglottitis
  • Mental status change
  • Rapidly deteriorating pulmonary status
  • Fatigue
196
Q

Increase of PCO2 by 10 mm Hg causes a decrease in pH by ___

A

0.08

Likewise, a decrease of PCO2 by 10 mm Hg will increase pH by 0.08

So an acute increase in CO2 to 60 should cause a drop in pH to 7.24 (consider normal PCO2 is 40)

197
Q

Hypoxemia =

A

Decrease PO2 in blood, < 75

198
Q

Hypoxia =

A

A low O2 state

199
Q

A-a gradient is a measure of ___

A

Efficiency of lung

200
Q

How to calculate PaO2 (formula)

A

PaO2 = (PB - PH2O) x (FiO2) - (PaCO2/0.8)

PB = atmospheric pressure, 760 mm Hg
PH2O = vapor pressure, 47 mm Hg
201
Q

Normal A-a is approximately ___

A

Age/3

202
Q

A-a gradient is ___ during anesthesia and with intrinsic lung disease (i.e.: PTX, PE, shunt, V/Q mismatch, diffusion problems)

A

Widened

203
Q

A-a gradient is normal with ___ or ___

A

Hypoventilation or low FiO2

204
Q

Treatment of hypoxemia/hypoxia

A

TREAT UNDERLYING CAUSE!!!

205
Q

A decrease in bicarbonate by 10 mmoles decreases pH by ___

A

0.15

An increase in bicarbonate by 10 mmoles increases pH by 0.15

A bicarbonate of 13 would result in a pH of 7.25 (consider normal bicarbonate is 23)

206
Q

Total body bicarbonate deficit =

A

Base deficit x weight in kg x 0.4; in meq/L

Usually replace 1/2 bicarbonate deficit

207
Q

Pulse ox is a ___ intraoperative monitor

A

Mandatory

208
Q

940 nm =

A

Infrared light, oxyhemoglobin

209
Q

660 nm =

A

Red light, deoxyhemoglobin

210
Q

What 2 hemoglobin variants affect pulse oximetry?

A

Carboxyhemoglobin (COHb)

Methemoglobin (MetHb)

211
Q

Carboxyhemoglobin shows a SPO2 of ___

A

100%—overestimation of true oxygenation

212
Q

What is used to distinguish between CO and oxygen levels?

A

Co-oximetry

213
Q

Cyanosis is seen in methemoglobinemia when ___ of Hb is in methemoglobin form

A

15%

214
Q

Methemoglobin shows a SPO2 of ___

A

85%

215
Q

Treatment of methemoglobinemia

A

Methylene blue or ascorbic acid

216
Q

What two things do NOT affect pulse oximetry?

A

Fetal hemoglobin and bilirubin

217
Q

Capnography indicates ___ but does not reliably detect ___

A

Esophageal intubation; endobronchial intubation

218
Q

What is the gold standard for tracheal intubation?

A

+ ETCO2

219
Q

Capnometer

A

Measures CO2

220
Q

Capnograph

A

Records and displays CO2

221
Q

CO2 are depicted graphically as a ___

A

Capnogram

222
Q

CO2 is recorded by a ___

A

Capnograph

223
Q

CO2 is measured by a ___

A

Capnometer

224
Q

What point on the capnograph is the recorded ETCO2?

A

D point

225
Q

In the awake and lateral position, the ___ lung is better perfused and ventilated

A

Dependent

226
Q

Under anesthesia with a decrease in FRC, the ___ lung ventilates more

A

Upper lung; creates a V/Q mismatch

227
Q

What are 6 factors that inhibit hypoxic pulmonary vasoconstriction?

A
  • Very high or very low PA pressures
  • Hypocapnia
  • High or very low mixed venous PO2
  • Vasodilators—NTG, Nitroprusside (SNP), beta-adrenergic agonists (dobutamine), calcium channel blockers
  • Pulmonary infections
  • Inhalation agents
228
Q

How does Hypocapnia affect HPV?

A

Inhibits HPV

229
Q

How do vasodilators like NTG and Nitroprusside (SNP) affect HPV?

A

Inhibit HPV

230
Q

How do inhalation agents affect HPV?

A

Inhibit HPV

231
Q

What do you want to set the FiO2 for one lung ventilation?

A

80-100%

232
Q

Tidal volumes for one lung ventilation

A

10cc/kg

233
Q

What do you use to ensure proper ETT placement during one lung ventilation?

A

Fiber optic scope

234
Q

Where do you want to keep PaCO2 during one lung ventilation?

A

Keep PaCO2 at 40 mm Hg

235
Q

Add 5 cm H2O CPAP to ___ lung

A

Nondependent (upper) lung—warn surgeon

236
Q

Add 5 cm H2O PEEP to ___ lung

A

Dependent lung—treats atelectasis but may increase vascular resistance

237
Q

Increase both CPAP and PEEP ___ during one lung ventilation

A

Slowly

238
Q

During apnea, PCO2 increases ___ mm Hg for the first minute and then ___ mm Hg for each additional minute of apnea

A

5 mm Hg for first minute; 3 mm Hg for each additional minute

Example: if PCO2 was 40, then after 10 minutes of apnea, the PCO2 will be 72.

239
Q

Progressive respiratory acidosis limits hypoxia during one lung ventilation to ___ minutes

A

10-20 minutes

240
Q

First most sensitive sign of MH =

A

Unexplained tachycardia

241
Q

Most specific sign of MH =

A

Increasing ETCO2–hypercapnia 2-3x normal

242
Q

Initial ABG for MH

A

Initial metabolic acidosis, then a combined metabolic and respiratory acidosis

243
Q

Dantrolene dosage for MH

A

2.5 mg/kg every 5 minutes

244
Q

Max dose of dantrolene for MH

A

10 mg/kg

245
Q

After MH has subsided, continue to give how much dantrolene?

A

1 mg/kg every 6 hours for 72 hours

246
Q

What should not be given to the MH patient while on dantrolene?

A

Calcium channel blockers—can cause life-threatening hyperkalemia/myocardial depression

247
Q

Persistent ventricular arrhythmias during MH should be treated with ___

A

Procainamide…NOT calcium channel blockers

248
Q

How does dantrolene work?

A

Muscle relaxant that works directly on the ryanodine receptor to prevent the release of calcium—it inhibits Ca release from the sarcoplasmic reticulum

249
Q

What drugs cause MH?

A

All inhalation agents (except nitrous) and succs (depolarizing muscle relaxant)

250
Q

Does propofol cause MH?

A

No!

251
Q

Do non-depolarizing muscle relaxants cause MH?

A

No! Depolarizing muscle relaxant SUCCS does cause MH

252
Q

What is the gold standard pre-op test for MH?

A

Muscle biopsy with halothane-caffeine contracture test—78% specific, 97% sensitive

Caffeine causes muscle to contract

Halothane in the MH patient causes more forceful contraction

253
Q

Does a prior uneventful general anesthetic rule out the possibility of MH?

A

NO!

254
Q

Who has the highest MAC requirement?

A

Term infant to 6 months of age

255
Q

Hyperthermia ___ MAC

A

Increases

256
Q

Chronic EtOH abuse ___ MAC

A

Increases

257
Q

Hypernatremia ___ MAC

A

Increases

258
Q

Drugs that increase CNS catecholamines ___ MAC

A

Increase

259
Q

Pregnancy ___ MAC

A

DECREASES

260
Q

Hypothermia ___ MAC

A

Decreases

For every 1 deg C drop in body temp, MAC decreases 2 to 5%

261
Q

Acute EtOH ingestion ___ MAC

A

Decreases

262
Q

What are 5 factors that have NO EFFECT on MAC?

A
  • Thyroid gland dysfunction
  • Duration of anesthesia
  • Gender
  • Hyper/hypokalemia
  • Hyper/hypocarbia
263
Q

What is the second gas effect?

A

Large volume uptake of a first gas (nitrous) accelerates the delivery of a second gas, thus speeding induction

264
Q

What is diffusion hypoxia?

A

Large amount of nitrous dilutes alveolar O2 concentration, causing hypoxia

265
Q

High risk pts for diffusion hypoxia?

A

Patients with a concurrently decreased FRC:

  • Pregnancy
  • Obesity
  • Children
266
Q

How can you avoid diffusion hypoxia?

A

Administer 100% O2 following N2O use

267
Q

Nicotine from smoking stimulates ___

A

Sympathetic ganglia—catecholamine release

268
Q

Nicotine causes catecholamines to be released from ___

A

Adrenal medulla

Increase HR, BP, and SVR

269
Q

Sympathetic stimulation from nicotine persists ___ after last cigarette

A

30 minutes

270
Q

How does smoking irritate the airway?

A
  • Increased mucus production
  • Decreased ciliary clearance
  • Increased inflammation
  • Reduced surfactant
271
Q

What should you, the anesthesia provider, do when prepping a case for a smoker?

A

Pre-oxygenate well and avoid instrumentation of airway until deep level of anesthesia is achieved

272
Q

Advise smokers to stop smoking at least ___ prior to surgery

A

12 hours

273
Q

If patient stops smoking night before surgery (12-24 hours), COHb and nicotine levels will be reduced to that of ___

A

Non-smokers

274
Q

Airway reactivity decreases after ___ days of cessation

A

2 days

275
Q

Airway reactivity is near the level of a non smoker after ___ days of cessation

A

10 days

276
Q

Cessation of > 8 weeks will reduce ___

A

Post-op pulmonary complications

277
Q

Cessation of > 2 years will reduce risk of ___

A

MI to that of nonsmoking population

278
Q

Severe emphysema requires longer ___

A

Expiratory times

Normal I:E is 1:2, so in COPD —> 1:3

279
Q

Closely monitor ___ to avoid rupturing an emphysematous blob or bullae, PTX

A

Peak inspiratory pressures (PIP)

280
Q

CO2 retainers—ETCO2 should be kept near ___; a rapid correction will lead to ___

A

The patient’s baseline; metabolic alkalosis

281
Q

Caution using ___(what inhalation gas) in COPD patients; may expand bullae and worsens pulmonary HTN

A

Nitrous oxide

282
Q

What 2 inhalation agents could cause airway stimulation and should not be used in COPD patients?

A
  • Desflurane

- Isoflurane

283
Q

What is worsened after inhalation agents?

A

Mucociliary clearance—results in lots of secretions…suction ETT frequently

284
Q

Avoid ___ to prevent bronchospasm in COPD patients

A

Histamine releasing drugs—Pentothal (STP), morphine, atracurium, mivacurium, neostigmine

285
Q

Treat patient with ___ to minimize chance of bronchospasm, especially before extubation

A

Nebulized albuterol

DNURS 827 Advanced Physiology/Pathophysiology for Anesthesia I (11 decks)

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