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Summer 2020 - Advanced Anesthesia - CV > Anesthesia for Thoracic Procedures - Final Wrapup > Flashcards

Anesthesia for Thoracic Procedures - Final Wrapup Flashcards

1
Q

What is the FVC for High Risk Patients?

A

< 50%

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2
Q

What is the FEV1 for High Risk patients?

A

< 2L

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3
Q

What is the FEV1 / FVC for High Risk patients?

A

< 50%

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4
Q

What is the RV/TLC for High Risk patients?

A

> 50%

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5
Q

What is the Diffusion Capacity for High Risk patients?

A

< 50% predicted

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6
Q

What are the Intrinsic PFT changes for a pt w/ Restrictive Lung disease?

A

↓FVC

Everything else stays normal

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7
Q

What are the Extrinsic PFT changes for a pt w/ Restrictive Lung Disease?

A

↓FVC

↑RV/TLC

Everything else normal

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8
Q

What are the PFT Changes for pts w/ Obstructive Lung Disease such as Asthma, Bronchitis, and Emphysema?

A

↓FEV1

↓FEV1 / FVC

↑RV / TLC

Normal FVC

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9
Q

What does Pulm. HTN look like on a Chest X-Ray?

A

Dilated Pulm. Vessels

COPD - Hyperinflated w/ Low Flat Diaphragm

RVH - Clockwise Cardiac Rotation w/ Loss of Air Space behind sternum

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10
Q

What should pts be instructed to do before Thoracic Surgery?

A

Stop Smoking

Breathing Exercises

Mucolytics/Expectorants

Bronchodilation Meds

Lose Weight

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11
Q

What are some meds that cause Bronchodilation?

A

Aminophylline - PDE Inhibitor increases cAMP

Cromolyn Sodium - Mast cell Stabilizer

Parasympatholytics

Sympathomimetics

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12
Q

How do Sympathomimetics cause Bronchodilation?

A

Beta Agonists increases cAMP

Metaproterenol

Albuterol

Terbutaline

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13
Q

How do Parasympatholytics help w/ Bronchodilation?

A

Decreases cGMP, which causes Bronchoconstriction

Atropine

Ipratropium Bromide

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14
Q

Which med is useful for Left-sided HF or SVT?

A

Digitalis

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15
Q

In the Lateral Decubitus Position, which Lung is better Perfused?

A

Down Dependent Lung

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16
Q

In the Lateral Decubitus Position, which Lung is better Ventilated?

A

Up Non-Dependent Lung

17
Q

What are the Advantages of the Lateral Decubitus position for Thoracic Surgery?

A

Hemithorax Access

Easy to Extend Incision

Easy to Tilt Pt.

Safest for Hilar Dissection

Control of Hilar Vessel

18
Q

What are Disadvantages to the Lateral Decubitus Position for Thoracic Surgery?

A

Opposite Hemithorax Inaccessible

V/Q Mismatch

Down Dependent Lung Contamination

↓FRC, Airway Closure, Atelectasis of Down Lung

Positional Injury

19
Q

How can the Lungs be Separated?

A

Doubel Lumen ETT

Univent ETT

Bronchial Blockers

20
Q

When is Lung Separation Absolutely Indicated?

A

Prevent Cross Contamination

Ventilation Redistribution

Unilateral Bronchopulmonary Lavage

21
Q

What anesthetic should be avoided in one Lung Anesthesia?

A

N2O

22
Q

How should Hypoxia during One Lung Ventilation be managed?

A
  • CPAP to Up, Non-Dependent, Deflated, Operative Lung
  • PEEP to Down, Dependent, Lung
  • Return to 2 Lung Ventilation
  • Ask MD to clamp Rt. Pulm. Artery
23
Q

What are Contraindications to a Double Lumen ETT?

A

Lesions

Difficutly getting Direct Vision Intubation

Pts who cant tolerate Apnea

Full Stomach

24
Q

What are the concerns w/ Rigid Bronchoscopy?

A

Shared Airway

Arrhythmias

HTN

Hypoxemia

25
Q

What should be evaluated in regards to Rigid Bronchoscopy?

A

Lesion Level

Ischemic Processes

Lung Sounds

26
Q

What type of meds should be used for Rigid Bronchoscopy?

A

Robinul

&

Short Acting Anesthetics

27
Q

What are the Absolute Contraindications for Fiberoptic Bronchoscopy?

A

Unstable CV System

Life-Threatening Arrhythmias

Severe Hypoxemia

28
Q

What is to be expected w/ Fiberoptic Bronchoscopy?

A

Coughing

HTN

Tachycardia

29
Q

What size should the ETT be if a Fiberoptic Bronch is going thru the ETT?

A

7.5 - 8.0

30
Q

What size should the ETT be if a Fiberoptic Bronch is going Next to the ETT?

A

5.0 - 6.0

31
Q

What is Eaton-Lambert Syndrome?

A

Muscle Wasting

32
Q

What should be expected w/ Pneumonectomies?

A

Unrecognized Blood Loss

Post-Op Pulm. Edema & Atelectasis

Dysrhythmias

DVT/PE

Persistent Air Leak

33
Q

What can be a Life Threatening complication of a Pneumonectomy?

A

Excessive Mediastinal Shift

34
Q

What are signs of an Ipsilateral Mediastinal Shift r/t a Pneumonectomy?

A

Hypotension

Arrhythmias

Cardiac Herniation

Pulm. Edema

35
Q

What are signs of a Contralateral Mediastinal Shift r/t a Pneumonectomy?

A

↓Lung Function

&

↓Venous Return

36
Q

How should Chest Tubes be managed to Prevent Mediastinal Shifts?

A

Keep Clamped w/ Brief Unclamping to Drain

Summer 2020 - Advanced Anesthesia - CV (9 decks)

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