Obstructive Lung Disease Flashcards by Jeremy Steele

Dx of URI is based on:

Clinical symptoms (because viral cultures and lab tests lack sensitivity and are expensive)

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If Sx is cancelled due to acute URI, you should reschedule after _____ weeks due to ______

Schedule after 6 weeks due to airway hyper-reactivity

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Children w/ URI have a high risk of periop respiratory events with these symptoms: (4)

(PRAEs)

-Hypoxemia
-Laryngospasm
-Breath Holding
-Coughing

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Anesthetic management of URI patients

Adequate hydration
Reduce secretions
Limit airway manipulation

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What can you put on the vocal cords to reduce upper airway sensitivity?

Nebulized or Topical LA

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What type of airway can reduce risk of laryngospasm for a URI pt?

LMA better than ETT

less irritating

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What adverse event is a young pt with a URI at risk for?

Postintubation croup

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What are the main inflammatory mediators implicated in asthma? (3)

Histamine
Prostaglandin D2
Leukotrienes

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Asthma is inflammation in mucosa where?

Lower airway –> Bronchi

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In relation to exercise, Asthma attacks happen when?

Following the exertion
NOT during it

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Dangerous, life threatening bronchospasm that persists despite treatment

Status asthmaticus

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What should be focused on when obtaining hx from an Asthma pt? (4)

previous intubation
ICU admissions
2 + hosptitalizations in the past year for asthma
presence of coexisting dz

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Which disease partially improves with bronchodilators?

Asthma

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Normal FVC for females and males

Female: 3.7L
Male: 4.8 L

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Normal values for FEV1 test
What does this measure?
Values for Asthmatic?

Values between 80-120% of the predicted value
Severity of expiratory obstruction
Asthmatic: FEV1 < 35%

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FEV1/FVC ratio normal

75-80%

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Forced expiratory flow normal

25-75% of Vital capacity (measurement of airflow thru the midpoint of a forced expiration)

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Diffusing capacity with CO in asthma is

Not changed

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During moderate to severe asthma attacks how do lung volumes change?

FRC increases
RV increases
TLC remains normal

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Tachypnea during an asthma attack is due to ____ not ____

Neural reflexes

NOT hypoxemia

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PaO2 and PaCO2 values in mild asthma

Normal

PaO2: 100 mmHg
PaCO2: 40 mmHg

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PaCO2 is likely to increase when

FEV1 is < 25% of the predicted value

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First line treatment for mild asthma
This is only recommended if you have < ____ exacerbations/month

Short-acting inhaled B2 agonist
< 2

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This medication is reserved for severe asthma that is uncontrolled with inhalational medications

Systemic corticosteroids

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What is the only non-pharmacologic tx for refractory asthma?

Bronchial Thermoplasty

What is a Bronchoscopy used to deliver radiofrequency ablation of airway smooth muscles to all lung fields except the ______ ?

Bronchial Thermoplasty right middle lobe

Bronchial Thermoplasty is performed in ____ sessions and uses ____ via ____ ____ which brings with it a risk of ____ ____

3 **Ablation** via intense heat **airway fire**

When should asthma pts be intubated and put on mechanical ventilation?

When it is severe and their PaCO2 is > 50 mmHg

mechanical ventilation parameters for severe asthma pts:

high gas flows = short inspiration time, longer expiration time Expiration time must be prolonged to avoid air trapping and "auto-PEEP"

During anesthesia on asthma pt, the risk of ____ is higher with what types of surgery?

Bronchospasm upper abdominal surgery oncologic surgery

how does GA contribute to airway resistance in asthma pts?

1. depression of cough reflexes 2. reduction of palatopharyngeal muscle tone 3. depression of diaphragmatic function 4. increase fluid in the airway wall

In asthma, the degree of inflammation often mirrors the

Eosinophil count

Reduction in FEV1 or FVC to < ____% and/or FEV1:FVC ratio < ____% of predicted is a risk for periop respiratory complications

FEV1 or FVC < 70% FEV1:FVC < 65%

FEV1:FVC ratio of less than ____ is indicative of ____

80% Obstructive lung dz

When is a stress-dose hydrocortisone or methylprednisone indicated?

If the patient had been on systemic corticosteroids within the past 6 months

Definitive Dx of COPD is made w/ _______ PFT show: ______ FEV1:FVC ratio FEF _______ % of vital capacity

Spirometry Decreased FEV1:FVC ratio FEF 25-75% of VC

Common findings of COPD FEV:FVC ratio < ____% _____ FRC and TLC _____ DLCO _____ RV _____ VC _____ RV: TLC ratio

FEV:FVC ratio < 70% Increased FRC and TLC Reduced DLCO Increased RV Decreased VC Increased RV: TLC ratio

Stage 1 (mild COPD)

FEV1 ≥ 80% predicted

Stage 2 (moderate COPD)

50% ≤ FEV1 ≤ 80% predicted

Stage 3 (Severe COPD)

30% ≤ FEV1 ≤ 50% predicted

Stage 4 (Very severe COPD)

FEV1 < 30% predicted

What CXR finding suggests emphysema What CXR finding CONFIRMS emphysema What test is more sensitive at diagnosing COPD over CXR?

Hyperlucency in lung periphery Bullae confirm (only small % have it) Chest CT

What is the BODE index and what does it indicate?

BMI Obstruction (degree of) Dyspnea Exercise tolerance higher score = higher risk for COPD exacerbations, hospitalizations, and death

high eosinophil levels =

High inflammation present --> need for inhaled glucocorticoids

Low eosinophil levels =

poor response increased risk for pneumonia

To reduce the risk of death, COPD pts need ____ ____ when the PaO2 is ____ and the HCT is ____ or there is evidence of ___ ______

Home O2 Pa O2 is < 55 mmHg HCT is >55% evidence of Cor Pulmonale

anesthesia management for reduction in lung volume Sx includes:

Double lumen ETT Avoid Nitrous minimize excessive airway presssure DO NOT rely on CVP for fluid status

An important history fact to know for anesthesia management of COPD pt

previous need for NIPPV or mech. ventilation

Which Asthma medications should be held prior to Sx?

None They should all be given pre-op

What is more predictive of pulomonary complications surrounding sx than spirometric tests?

Clinical findings: Smoking Wheezing productive cough

What are pre-op indications for a pulmonary evaluation?

Respiratory acidosis complications: Bicarb > 33 mEq/L PCO2 > 50 mmHg

The single most important risk factor for developing COPD is

Smoking

The max benefit of smoking cessation is not seen until smoking has been stopped for:

More than **8 weeks**

CO and nicotine adverse effects on the O2 carrying capacity is: Elimination 1/2 life of CO is:

short-lived 4-6 hours

12 hours after smoking cessation, the P50 value increases from ____ to ____ mmHg, and plasma carboxyhemoglobin decreases form____ to ___%

P50 inc. from 22.9 mmHg to 26.4 mmHg Plasma levels of carboxyHb decrease from 6.5% to 1%

Smoking is an ____ of hepatic enzymes. After ____ the hepatic enzyme activity should return to normal

Inducer 6 weeks or longer (after stopping smoking)

What drug can help with smoking cessation?

Sustained release Bupropion (start 1-2 weeks before stop smoking)

Bronchiectasis signs:

irreversible airway dilation (feels like something is stuck in throat) inflammation chronic bacterial infection

Bronchiectasis prevelance is highest in:

pts > 60 yrs old w/ chronic pulm. dz (asthma & COPD) women

Dx of cystic fibrosis is the presence of:

Sweat chloride concentration >60 mEq/L

______ normally produces a protein, which helps in salt and water movement in and out of cells mutation of this gene leads to abnormally thick mucus

CFTR Gene (Cystic Fibrosis Transmembrane conductance Regulator)

In cystic fibrosis, exocrine pancreatic insufficiency leads to malabsorption of _____ and _____

fats and fat-soluble vitamins (ADEK)

The primary cause of morbidity and mortality in cystic fibrosis is

chronic pulmonary infection

Kartagener Syndrome is a triad of

Chronic sinusitis Bronchiectasis Sinus inversus (chest organ position inverse)

Humidification, hydration, and avoidance of anticholinergic drugs are indicated in what disease?

Cystic Fibrosis

in Cystic fibrosis, ___ ___ may be necessary if ____ function is poor or ____ ____ function is impaired

Vit. K hepatic function Exocrine pancreatic function

Which pts should regain full ____ ____ adequate TV & ____ prior to ______

Cystic fibrosis pts should regain: full airway reflexes TV & RR prior to extubation

In the presence of dextrocardia with ____ ____ pts, the position for ____ is ____

Kartagener syndrome ECG is reversed for accurate interpretation

Reduced FEV1 and FEV1:FVC ratio that is unresponsive to bronchdilators is a sign of

Bronchiolitis Obliterans

Tracheal stenosis becomes symptomatic when

the lumen is decreased to <5mm in diameter

Anesthesia management of tracheal stenosis

dilation via balloon dilators tracheobronchial stent resection and reconstruction of trachea (most successful Tx)

Obstructive Lung Disease Flashcards

(71 cards)