Exam II - reactice airway V Flashcards
(54 cards)
What is the increased reactivity seen with smoking?
coughing, laryngospasm, bucking, bronchospasm, wheezing, breath holding
Why do smokers have a chronic productive cough?
smoking decreases ciliary motility and increases sputum production
When should smokers stop smoking before surgery?
-ideally they should stop smoking 30 days prior to surgery otherwise no real benefit
What carboxyhemoglobin levels are seen in smokers and non-smokers?
normally <1%; in smokers can be as high as 8-10%
What effect does carboxyhemoglobin have on the heart?
negative inotropic = decreased contractility
Smokers develop obstructive disease which can lead to what physiologic effects?
- V/Q mismatch, gas trapping, flattened diaphragmatic configuration, barrel chest deformity.
- two to six-fold increase in postop pneumonia development and PPC (post-op pulmonary complications)
Before surgery what should you assess for with smokers related to pulmonary status?
- Make sure no active pulmonary infection
- Give bronchodilator before surgery if they normally take one
What are post-op complications seen in smokers and what is the biggest determinate of PPC?
- pneumonia and atelectasis
- increased mucous production
- operative site is the single most factor of determinants of PPC (non-laparoscopic upper abdominal procedures , followed by lower abdominal and thoracic procedures)
- epidural analgesia best
- operations > 3 hours associated with higher rates of PPC
- advanced age
What could you do to treat decreased radial traction (airways collapsed and not held open) on small airways reduces cross-sectional area in patients with COPD or with decreased lung volume secondary to obesity, surgical manipulation, excessive lung water, or splinting?
Recruitment maneuver (PEEP)= close pop off valve on bag to increase pressure then squeeze bag and force air in distal airway
What are signs of inadequate post-op ventilation
o tachypnea o anxiety o dyspnea o labored ventilation o increased SNS activity (tachycardia, HTN)
What effects can be seen from not smoking for one night?
- reduces heart rate, blood pressure and circulating catecholamine levels, decreases carboxyhemoglobin levels.
- However, it may increase their risk of PPC (Postoperative Pulmonary Complications) due to increases in mucous
What is Asthma?
- chronic disease char by “chronic airway inflammation, reversible exp airway obs with airway narrowing in response to bronchial hyperreactivity”
- periods of remissions and exacerbations
- permanent changes in airway anatomy (airway remodeling) magnify the inflammatory response
- Asthma is *Reversible COPD is not
Precipitating factors of asthma
airborne allergens medications (histamine releasing, aspirin, sulfa agents, NSAIDS) pollution exercise occupational infection emotional stress *
What is the most common the of asthma?
- *allergic asthma is the most common type particularly in children
- IgE mediated
- usually history of allergic diseases, positive skin reactions, ↑
What is the pathogenesis of allergen-induced asthma?
- in predisposed atopic individuals, antigen exposure leads to synthesis and secretion of specific immunoglobulin (E), antibodies.
- Family history of allergic disease
- IgE affixes itself to plasma cells in the bronchial smooth muscle in the wall of the airway. Once this occurs, there is a release of mediators from granules in the mast cells.
What are the mediators released from granules in mast cells once IgE attaches to bronchial smooth muscle in airway?
- **histamine
- **slow releasing substance of anaphylaxis (SRSA)
- leukotrienes (potent spasmodic; proinflammatory substances)
- interleukins
- eosinophilic chemotactic factor (ECF-A)
- bradykinins
All of the above compounds increase inflammation, increased smooth muscle tone and hyperactivity. Eosinophils infiltrate the airways during the hours following allergen exposure and leads to the release of mediators
Can you treat bronchial smooth muscle bronchoconstriction with muscle relaxant like we do with laryngospasms?
- No
- treat with bronchodilator or beta agonist
What is another name for allergic-induced asthma?
Extrinsic asthma- external source
What are Curschmann’s spirals seen with with extrinsic asthma?
- thick, tenacious spiral shaped secretions that occlude the airway (mucous plug)
- These secretions generally reveal hypereosinophilia consistent with an allergic process either initiating or complicating episodes of airflow obstruction
What is another type of asthma that is not allergy induced?
Abnormal Autonomic Nervous System Regulation of Airway function (Intrinsic or Idiosyncratic)
What causes Intrinsic or Idiosyncratic asthma?
- abnormal regulation of neural function
- imbalance of between inhibitory (bronchodilation) and excitatory (bronchoconstriction) neural input
- smooth muscle function is modulated by cyclic GMP or cyclic AMP.
- Usually in response to noxious stimuli (cold, exercise, airway instrumentation, climate, airway illness)
What does an increase in cyclic AMP do?
-**increases in cyclic AMP result in relaxation of bronchial smooth muscle
What does an increase in cyclic GMP do?
-**increases in cyclic GMP results in constriction of bronchial smooth muscle
Stimulation of the sympathetic nervous system causes what in the lungs?
bronchial relaxation or bronchodilation
