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Marcus HA S24 > Exam 4 obstructive > Flashcards

Exam 4 obstructive Flashcards

1
Q

What diagnosis obstructive sleep apnea?

A

– Polysomnography recording

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2
Q

What does it look at?

A

Apnea, hypopnea, respiratory effort-related arousal

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3
Q

What kind of reduction of air flow is considered apnea?

A

90%

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4
Q

What is an obstructive apnea event?

A

Breathing effort during apnea

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5
Q

What is a central apnea event?

A

No breathing effort during apnea

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6
Q

How long does an apnea event have to last to be counted?

A

10sec

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7
Q

What is the AHI?

A

The number of apnea & hypopnea events in an hour

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8
Q

An AHI >15 means what?

A

Pt has OSA

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9
Q

What are the criteria for OSAS?

A
  • AHI >5
  • daytime somnolence > 2wks
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10
Q

What does one have to be very aware of when inducing a Pt with an AHI >30?

A

Pt’s sats can drop from 100% to 30% quick on induction. Be very aware with these Pt’s

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11
Q

What are some metabolic consequences of OSA?

A
  • Systemic inflammation
  • ↑SNS activity
  • hormonal changes
  • insulin resistance
  • metabolic syndrome
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12
Q

What are the most common sites for airway narrowing?

A

Retropalatal and retroglossal regions of the oropharynx

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13
Q

What kind of obstruction will be seen a lot?

A

Excess soft tissue/tonsils

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14
Q

What is functional collapse?

A

Forces that can collapse the upper airway > the forces that dilate the upper airway

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15
Q

What increases airway obstruction while supine?

A

Increases the effect of extraluminal positive pressure against the pharynx

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16
Q

What stimulates the arousal response?

A

Hypercapnia, hypoxia, upper airway obstruction & work of breathing

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17
Q

What are the day S/S of sleep apnea?

A
  • Dry mouth or headache upon waking
  • sleepiness
  • falling asleep during monotonous situations
  • subjective impairment of cognitive function
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18
Q

What are the night S/S of sleep apnea?

A
  • Frequent awakening
  • awaking from own snoring w/ choking sensation
  • loud snoring
  • observed pauses in breathing during sleep
  • tachycardia
  • non-restorative sleep
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19
Q

What are the risk factors for OSA?

A

Age, obesity, minorities, male, pregnancy, smoking

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20
Q

What surgery is recommended for OSA?

A

Maxillomandibular advancement (MMA)

21
Q

What does the electrical stimulation surgery do for someone with OSA?

A

It stimulates hypoglossal nerve → contracts to keep airway open. (Very expensive)

22
Q

A Mallampati score of 2 results in what odds for OSA?

A

A 5 point increase for odds of Pt having OSA

23
Q

What does STOP-Bang stand for & what does it check?

A

A scale to show risk for OSA (Pts that have not been diagnosed for OSA)
Snore, Tired, Observed, Pressure, BMI >35, Age >50, Neck >17”, Gender (male)

24
Q

What anesthetic considerations are there for a Pt with OSA?

A
  • Less is more
  • Elevate HOB
  • Pre-oxygenate
  • Possible difficult intubation
  • Use minimal to no opioids
  • Regional is better than GA
25
What are the S/S for an URI?
- Nonproductive cough - sneezing - rhinorrhea
26
How long is elective Sx delayed for a current URI?
6wks
27
When do you proceed with Sx in someone that has a URI?
If S/S are getting better → proceed w/ sx
28
What equipment is preferred for someone with an URI?
- An LMA > ETT - If using ETT use lidocaine & suppress SNS airway stimulation or nebulizer with lidocaine in pre-op
29
What are possible adverse induction events for someone with an URI?
- Bronchospasm - laryngospasm - airway obstruction - postintubation croup - desaturation - atelectasis
30
What stimuli provoke asthma?
Allergens, ASA, NSAIDs, beta-antagonist, infections, exercise, stress, endorphins & vagal mediation
31
Where specifically is the airway edema in asthma?
In the bronchi
32
What inflammatory mediators are released in asthma?
- Histamine - prostaglandin D2 - leukotrienes
33
How is asthma diagnosed?
Airflow obstruction on pulmonary function testing that is at least partially reversible with bronchodilators
34
What are the usual PFT results in someone with asthma?
- FEV1 < 35% of normal - FRC - may increase substantially - TLC - within normal range
35
What PaO₂ indicates severe asthma?
PaO₂ <60 mm Hg on room air
36
When is an asthmatic Pt stress dosed?
If been on IV or PO steroids for while then give stress dose
37
What are the 2 meds that have long-acting bronchodilator & steroid combo?
- (Symbicort) Budesonide + formoterol - (Advair) Fluticasone + salmeterol
38
What induction drugs are best for asthma Pt’s?
- Lidocaine, propofol or ketamine - Avoid histamine-releasing NMBDs
39
What are the risk factors for COPD?
Pollution, recurrent childhood resp infections, low birth weight, asthma, age, female, poor lung development, lower socioeconomics
40
What are the S/S for COPD?
- Dyspnea on exertion or at rest, chronic cough, and chronic sputum production - Exacerbations… acute worsening airflow obstruction - Tachypnea and prolonged expiratory time - Decreased breath sounds, expiratory wheezes
41
When does a COPD’er get long-term O2 therapy?
PaO2 <55 mmHg, Hct >55% or cor pulmonale
42
What is the PaO2 goal for a COPD’er?
>60 mmHg
43
What would we want a COPD’er albumin level to be?
At least 3.5 mg/dL (lower albumin = increased pulm risks)
44
Which abnormal ABG labs would lead to an Pulmonology consult?
- Bicarbonate > 33 mEq/L - PCO2 > 50 mm Hg
45
What VA agent is best suited for a COPD'er?
Sevoflurane
46
What VA agent should be avoided with COPD'ers?
Nitrous oxide
47
What is the minimum time a smoker should stop smoking before elective surgery?
Minimum 6 weeks
48
– What is the elimination half-life of carbon monoxide?
approximately 4–6 hours

Marcus HA S24 (11 decks)

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