COPD Flashcards
(37 cards)
COPD Review It includes: •chronic bronchitis with obstruction of ? •Emphysema with \_\_\_\_\_\_\_\_\_\_ of air sacs •Destruction of lung \_\_\_\_\_\_\_\_
- small airways
- enlargement
- parenchyma
COPD: Emphysema /Bronchitis
➢COPD contrasts with asthma in that the obstruction is either not _________ or incompletely reversible by _________
➢Cell death and destruction of the ________ is due to impaired lung parenchyma, degraded matrix, and toxic actions of _________ cells (specifically macrophages and neutrophils)
➢Results in enlargement of _______, fibrosis, and increased _______ production
- reversible, bronchodilators
- alveoli, inflammatory
- air spaces, mucus
COPD: Emphysema/Bronchitis (Cont)
➢Inflammation process In COPD- _________ have limited effect.
➢____________ help in reducing frequency of exacerbations and
➢__________ have modest role in air outflow with patient suffering from chronic breathlessness “worsened by exertion”
- steroids
- inhaled corticosteroids
- bronchodilators
COPD and Hyperresponsive Airways
➢COPD does not have many of the markers of _______ that are found in asthma
●Serum ____ levels
●Skin test reactivity to allergens
●Eosinophilia
- atophy
* IgE
Review:Pathophysiology (COPD) ----> Risk Factors
●\_\_\_\_\_\_\_\_\_\_\_
●Passive smoking ?
●Ambient air pollution ?
●Hyperresponsive airways ?
●\_\_\_\_\_\_\_\_\_ Infection?
●Occupational factors ?
●\_\_\_\_\_\_\_\_\_\_ deficiency
*Only known genetic abnormality that leads to COPD
*Accounts for less than- cigarette smoking
- respiratory
- alpha 1- antitrypsin deficiency
Review:Pathophysiology ➢Anatomic Changes *Enlargement of \_\_\_\_\_\_\_\_\_ glands *\_\_\_\_\_\_\_\_\_\_\_ inflammatory process *Emphysema *Bronchoconstriction *Pulmonary \_\_\_\_\_\_\_
- bronchial mucus
- mononuclear
- fibrosis
FEV1/FVC ratio in COPD?
- decrease
COPD: ***Pink Puffer = ________
➢(PaO2 ____, ______ PaCO2)
➢Thin, anxious, purse lips
➢Accessory muscles, dyspnea
➢___ secretions, markedly diminished breath sounds
➢With resp infx right -sided heart compromise
➢CXR- ________ low diaphragm
- emphysema
- PaO2 >60, normal PaCO2
- scant
- hyperinflation
COPD: **** Blue Bloater = ? ➢(PaO2\_\_\_\_, PaCO2 \_\_\_\_) ➢Overweight, cyanosis dusky appearance ➢Cough, \_\_\_\_\_\_ secretions ➢Diminished breath sounds ➢\_\_\_\_\_\_\_\_\_ / cor pulmonae ➢CXR- increased \_\_\_\_\_\_\_\_ markings
- chronic bronchitis
- PaO2 less than 60, PaCO2 greater than 45
- copious
- R sided heart failure
- broncho-vascular
The Anesthesia Plan: Signs of increased risk on History/Physical ● \_\_\_\_\_\_\_\_ ●Chronic \_\_\_\_\_ ●Dyspnea ●Absent breath sounds or \_\_\_\_\_\_\_ ●Prolonged \_\_\_\_\_\_\_\_
- exercise intolerance
- cough
- wheezing
- exhalation
The Anesthesia Plan (con't) ➢Pre-operative Optimization ●Smoking \_\_\_\_\_\_\_\_ ● ? (think meds) ●Eliminate Infection
- cessation
* bronchodilation
Resp. Prep Maneuvers Dilate the Airway/Treatment Bronchospasm
- Sympathomimetics: increased cAMP causes _________
- Steroids -> ________
- PDE inhibitors - inhibits breakdown of ______
- Cromolyn - ______ stabilization
- bronchodilation
- decrease mucosal edema
- cAMP
- mast cell
Preop treatment interventions:
Benefit to stop smoking ______ preop however no smoking after midnight (to decrease ______).
*_______ for evidence of respiratory infection
*Oxygen for ______ and/or evidence of increased pulmonary vascular resistance
*__________ to address reversible component, if present
*Hydration
- 8 weeks
- carboxyhemoglobin
- antibiotics
- hypoexmia
- bronchodilators
Preop treatment interventions con’t: Treatment is aimed at using
●Step 1-________ bronchodilators
●Step 2- regular inhaled ________
●Step 3- _______ bronchodilators
●Step 4- __________/Methylanthines/leukotriene inhibitor
●Step 5- regular ____ corticosteroid
●Other- ?
- short-acting
- corticosteroids
- long-acting
- phosphodiesterase inhibitors
- oral
- cromolyn
Smoking Cessation:
Smoking decreases _______ motility and increases _______ production
➢Produces airway _______ and development of obstructive disease
➢It is one of main and most prevalent risk factors associated with post-operative morbidity
➢2-6 fold risk of developing post-operative ________
- ciliary, sputum
- reactivity
- pneumonia
Smoking Cessation (con’t):
➢Best benefit to surgery is smoking cessation for _______ pre-operatively
➢____ abstinence may decrease carboxyhemoblogin level to normal but may increase risk of post-operative _________ complications
- 2 months
- 24 hr
- pulmonary
Smoking Cessation Time Course (Chart):
- 12-24hr: decreased ______ and nicotine levels
- 48-72hr: COHg normalized, _____ function improves
- 1-2wk: decreased _____ production
- carboxyhbg
- ciliary
- sputum
Smoking Cessation Time Course (con’t)
- 4-6wk: ____ improved
- 6-8wk: ______ function and metabolism normalizes
- 8-12wk: decreased overall ______ morbidity & mortality
- PFTs
- Immune
- postoperative
What should the preop evaluation include for this patient?
➢Counsel pt regarding: post op complications
●Atelectasis
●________, Hypoxemia
●Retention of _______
●Bronchospasm
➢Explain need for post op ________
- hypercapnia
- secretions
- ventilation
What is the goal for the anesthetic management of patients COPD:
➢Patients with obstructive disease are at risk for both intraoperative post-operative ________ complications
➢GOAL: Minimize the risk of postop respiratory failure.
➢__________ will blunt airway reflexes and reflex bronchoconstriction but consider the CV effects
- pulmonary
* volatile agents
What is the goal for the anesthetic management of patients COPD:
➢Regional anesthesia may offer benefits for surgery of the extremities and lower abdomen (not above ____?).
➢Judicious use of ________ – prevent and/or treat postop pain but avoid respiratory depression.
- T6
* opioids
The Anesthesia Plan
➢Induction
●Regional
•Good choice extremity surgery, +/- lower abdominal; consider that patient can not tolerate additional IV ________
•levels _____ should be avoided as they need their accessory muscles
- sedation
* >T6
The Anesthesia Plan (con’t): General Anesthesia
•No specific agent ‘ideal”-consider co-morbidities
•Volatile agents produce _________ and are rapidly eliminated
•Consider prolonged respiratory effects, use short acting ______
•titrate opioids carefully –resp depression
•consider less tolerance for respiratory depressant effects of all drugs
•Adjunctive IV administration of opioids and ________ prior to airway instrumentation will decrease reactivity
- bronchodilation
- NMB
- lidocaine
The Anesthesia Plan: Maintenance
●__________ = bronchodilation
●ETT ________ natural airway humidification : need to use humidifier and ______
- inhaled agents
- bypasses
- low flows
