Study guide flashcards

1
Q

when dealing with a mediastinal mass what type of intubation should you plan on

A

fiberoptic, spontaneous respiration

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2
Q

cause of leakage in lungs after thoracotomy

A

inflammatory mediators at alveolar-endothelial barrier

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3
Q

ALI - what causes stretching of capillaries?

A

fluid overload causes failure of micro vessels, disturbing permeability

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4
Q

Which side lung lobectomy is better tolerated and why

A

L lobectomy better tolerated because R lung is bigger and has more blood flow and oxygenation

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5
Q

What can occur during mediastinoscopy (besides hemorrhage and pneumo)

how/why?

A

Pressure on innominate artery–>decreased cerebral blood flow

reduces flow flow to:
R common carotid
R vertebral
Subclavian flow to R arm

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6
Q

How do we prevent/monitor for too much pressure on innominant artery

A
  1. Pulse ox and/or art line on R arm
  2. BP cuff on L to prevent interruption of R readings
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7
Q

In restrictive lung disease, there is a decrease in

A

All lung volumes and capacities

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8
Q

In obstructive lung disease, there is an increase in

A

RV, FRC, TLC

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9
Q

Dominant feature of obstructive lung disease/COPD

A

progressive airflow obstruction

Increased FRC, RV, TLC

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10
Q

What scenario causes the largest VQ mismatch?

A

Anesthetized, vented, paralyzed, one lung down, open chest

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11
Q

HPV is triggered by

A

alveolar hypoxemia

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12
Q

HPV only occurs in

A

pulmonary circulation

in regular circulation, hypoxemia causes vasodilation

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13
Q

HPV in OLV decreases blood flow by (amount)

A

50%

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14
Q

Blood flow in HPV (lung ratio)

A

80:20 instead of 60:40

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15
Q

Potential complicatino with inflating bronchial cuff

A

bronchial rupture form overinflation

1-3 mL of air in bronchial cuff

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16
Q

Bronchial lumen and RUL

A

Can obstruct more easily:

Carina to RUL: 2.5 cm compared to
Carina to LUL: 4-5 cm

consider using L DLT for R and L deflations unless there is a contraindication

17
Q

Main anesthetic goal in OLV

A

maintain adequate oxygenation. wile maintaining visualization of lungs for surgeon

18
Q

Hypoxemia in OLV

A
  1. 100% FiO2
  2. check tube placement
  3. CPAP
  4. PEEP
  5. Early PA ligation (if planned)
  6. resume 2 lung ventilation
19
Q

Following re-expansion of lung, be sure to

A

deflate bronchial cuff - avoids bronchial ischemia

20
Q

PA catheter and R lung collapse

A

PA will not give accurate readings

21
Q

Monitor placement for OLV

A
  1. art line on dependent arm for stabilization
  2. BP cuff on non-dependent arm to avoid interruption
22
Q

Thoracic surgery pt optimization best:

A

Cessation of smoking

23
Q

Within 2 months of cessation of smoking:

A

increased secretions –> increased complications

but patients with lung cancer should not wait longer than 2 months

24
Q

Assessing risk for thoracic surgery PFTs

A

Need PPO FEV1 (predicted post op FEV1)

traditional FEV1 is not enough

calculates traditional FEV1 by fraction of functioning lung or DLCO

25
Q

Diffusion capacity abbreviation

A

DLCO

26
Q

DLCO - what does it do

howcan in indicated complications

A

measures ability to transport gas across alveolar-capillary membrane

<60% = increased complications

27
Q

ABGs and predicting post op complications

A

SpO2 < 90% on RA is indicative of postop complication

28
Q

IF PPO FEV1 is <40%:

A

additional screening is needed

DLCO
V/Q scan
VO2 max

29
Q

What do high risk candidates look like for thoracic surgery:

FEV1
PPO FEV1
DLCO
VO2 max
Stairs
Oxygen desaturation

A

FEV1: <2L or < 40% predicted
PPO FEV1: <40%
DLCO: <40% predicted
VO2 max: < 10 mL/kg/min
Stairs: inability to climb one flight of stairs
O2 sats: desaturation >4% during exercise

30
Q

Most effective analgesia for thoracic surgery:

A

Thoracic epidural T6 - T8

*does not decrease HPV

31
Q

What increases bullae?

A
  1. N2O
    2.PPV
32
Q

Vt and rate with bullae

PIP gal

A

small Vt and faster RR

goal to keep PIP below 10-20 cm H2O

33
Q

PIP goal with bullae

A

below 10-20 cm H2O