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Final Exam - Obstructive Diseases Flashcards

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1
Q

What are the 4 obstructive diseases based on anesthetic management?

A
  • Acute URI
  • Asthma
  • COPD
  • Miscellaneous
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2
Q

What infection accounts for ~95% of URIs?

A

Infectious nasopharyngitis

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3
Q

What are the most common viral pathogens causing URI?

A
  • Rhinovirus
  • Coronavirus
  • Influenza
  • Parainfluenza
  • RSV
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4
Q

What patient population is at a higher risk of perioperative respiratory events?

A

Children

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5
Q

If a surgery is cancelled d/t a URI, when can they be rescheduled?
Why?

A

Must wait 6 weeks
Airway hyperactivity persists for this long

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6
Q

Anesthetic management of a patient with an acute URI?

A
  • Adequate hydration
  • Reduce secretions
  • Limite airway manipulation→LTA, LMA, deep extubation
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7
Q

Definition of asthma?

A

Chronic inflammation of the mucosa of the lower airways

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8
Q

What are the main inflammatory mediators in asthma?

A
  • Histamine
  • prostaglandin D2
  • leukotrienes
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9
Q

Asthma provoking stimulators?

A
  • Allergens
  • B antagonists
  • Aspirin
  • Infections
  • Exercise
  • Emotional Stress
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10
Q

What is a life threatening bronchospasm that persists despite treatment?

A

Status asthmaticus

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11
Q

Normal FEV1?

A

80-120% of predicted value

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12
Q

Normal FVC for females and males?

A

Females: 3.7 L
Males: 4.8 L

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13
Q

Normal maximum voluntary ventilation (MVV) for males and females?

A

Females: 80-120 L/min
Males: 140-180 L/min

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14
Q

Normal values for diffusing capacity (DLCO)?

A

17-25 mL/min/mmHg

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15
Q

What is the typical FEV1 in a symptomatic asthmatic?

A

FEV1 = < 35%

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16
Q

What may happen with the FRC, TLC, and DLCO during an asthma attack?

A

FRC: increase substantially (air trapping)
TLC: unchanged
DLCO: unchanged

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17
Q

What causes the hyperventilation during an asthma attack?

A

Neural reflexes of the lungs - not hypoxemia

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18
Q

Most common ABG findings in asthma?

A
  • Hypocarbia
  • Respiratory alkalosis

Hyperventilation

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19
Q

When does PaCO2 increase based on FEV1?

A

When FEV1 is < 25%

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20
Q

How can asthmatics become hypercarbic during an attack?

A

Fatigue of the respiratory muscles

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21
Q

1st line treatment for mild asthma?

A

Short acting β2 agonist
Recommended if < 2 exacerbations/ month

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22
Q

2nd line treatments for asthma?

A

Daily inhaled corticosteroids

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23
Q

When are systemic steroids needed for asthma?

A

Severe asthma- uncontrolled with inhalational medications

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24
Q

What can decreases the use of long-term medications in asthmatics?

A

SQ immunotherapy

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25
What is the only nonopharmacological treatment for refractory asthma? How does it work?
* Bronchial thermoplasty * Radiofrequency ablation of airway smooth muscle *except in right middle lobe* * Reduces airway muscle mass to reduce bronchospasm
26
At what FEV1 do asthmatics usually have little or no symptoms?
50% of normal
27
What IV steroids are used to treat acute severe asthma?
- Hydrocortisone - Methylprednisone
28
Mechanical ventilator parameters for asthmatics?
Short inspiration and long expiratory times to prevent air trappin and auto-PEEP
29
What is correlated to increased risk of intraoperative bronchospams in asthmatics?
- Type of surgery: increased with upper abdominal and oncologic surgery - How recent the last attack was
30
What lab value often mirrorsr the degree of airway inflammation?
Eosinophil count
31
What FVC and FEV1/FVC is a risk for peripo respiratory complications?
FVC < 70% predicted FEV1/FVC < 65% predicted
32
When do you stress dose steroids in asthmatics?
If they have been on systemic steroids within the past 6 months
33
What should the PEFR be before surgery?
> 80% of predicted of their personal best
34
What is the prevalance of COPD?
10%, 3rd leading cause of death
35
Diagnosis of COPD?
Made with spirometry (You know the normal lung and PFT findings from A&P)
36
Whhat is the staging of COPD based upon FEV1 measurement?
37
What may COPD patients have on CXR? What imaging is more sensitiive?
- Hyperlucency in lung periphery - Bullae confirms emphysema - CT more sensitive
38
This phenyotype of COPD causes alveolar destruction, loss of bone, fat, and muscle, and carries a higher risk of lung cancer?
Multiorgan loss of tissue (MOLT)
39
This phenyotype of COPD causes bronchiolar narrowing and wall thickening and is accompanied by metabolic syndrome and cardiac disease?
Bronchitic
40
What inherited disorder is associated with COPD?
⍺1-antitrypsin deficiency
41
What do high and low levels of eosinophils indicate in COPD patients?
High: need for inhaled corticosteroids Low: increased risk of pnemonia
42
When does PaO2 and PaCO2 decrease in severe COPD?
PaO2: FEV1 < 50% predicted PaCO2: even lower
43
What is the 1st step in COPD treament?
Smoking cessation
44
Medical treatments for COPD?
- LA antimuscarinics - LA β2 agonists - Inhaled gluccocorticoids - Flu/pneumonia vaccinces
45
When is long-term O2 recommended in COPD?
- Pao2 , < 55 mmHg - Hct > 55% - Evidence of cor pulmonae
46
What is the goal of supplemental O2?
Acheive PaO2 > 60 mmHg
47
What is more effective at decreasing PVR, pulm HTN, and preventing erythrocytosis?
Supplemental O2
48
When are diuretics indicated in COPD?
RH failure with peripheral edema
49
Surgical treatment for COPD?
Lung volume reduction surgery Removes overdistended tissues to allow normal tissue to expand
50
Anesthesia management in lung volume reduction surgery?
- DLT - Avoid N2O - Minimize AW pressures - CVP unreliable d/t surgical changes in intrathoracic pressures
51
What should be assessed is a paitent has pulmonary disesase?
RV function and echo
52
What patient related factors relate to post op pulmonary complications?
- Age > 60 - ASA class III or greater - CHF - existing pulm dx - Smoker
53
What lab finding can be a risk factor post op resp complications?
Albumin < 3.5 g/dL
54
When are the benefits of smoking cessation seen?
Max at 8 weeks after cessation | Short term cessation not benefical to prevent post op complilcations
55
What is the 1/2 life of CO?
4-6 hrs
56
Smoking can also stimulate ____ , and may take 6 weeks or longer to return to normal?
Hepatic enzymes
57
What drug can be started 1-2 weeks before smoking cessastion to help?
Buproprion
58
This disease is characterized by irreversible airway dilation, inflammation, and chronic bacterial infections?
Bronchiectasis
59
Bronchiectasis is most prevalent in:
- Pt > 60 - Chronic lung diseases - Women
60
Symptoms of bronchiectasis: Gold standard for diagnosis:
* Chronic productive cough * Purulent sputum * Hemoptysis * Nail clubbing * CT gold standard: shows dilated bronchi
61
Main treatments for bronchiectasis:
Abx and chest physiotherapy
62
Patho of cystic fibrosis:
- Mutation in cystic fibrosis transmembrane conductance regulator gene (CFTR) - Leads to abnormally thick mucous causing luminal obstuction and destrucion of glands and tissues - Malabsorption of fats from pancreatic insufficency
63
Primary cause of morbidity for cystic fibrosis?
Chronic pulmonary infection
64
How is cystic fibrosis diagnosed?
* Sweat chloride concentration >60 mEq/L * DNA analysis can identify the CFTR mutation
65
What sign of airway inflammation is present in cystic fibrosis?
Bronchoalveolar lavage shows a high percentage of neutrophils
66
All cystic fibrosis patients have:
COPD
66
What drug increases sputum clearance in CF?
Recombinant human deoxyribosenuclease
67
What is Primary Ciliary Dyskinesia?
* Congenital impairment of ciliary activity in resp tract and sperm/ovaries * Leads to chronic sinusitis, recurrent resp infections, and infertility
68
What is Kartagener syndrome?
Triad of chronic sinusitis, bronchiectasis and situs inversus (chest organ position is inversed)
69
When would you choose the left IJ for a CVC?
Inversion of the great vessels
70
Uterine displacement with PCS should be to the ____
Right; normally is to the left
71
What is bronchiolitis obliterans?
epithelial inflammation leading to bronchiolar destruction and narrowing
72
What intervention can minimize central airway obstruction during GETA?
High-volume, low pressure cuffs on ETT
73
When does tracheal stenosis become symptomatic?
When the tracheal lumen is < 5 mm
74
Anesthesia considerations for tracheal stenosis?
- Translaryngeal intubation - high frequency ventilation - Addition of helium (decreases density of gas mixture and improves gas flow)

Assessment (23 decks)

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