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Apex Review > Respiratory pathophysiology 7 > Flashcards

Respiratory pathophysiology 7 Flashcards

1
Q

Here are the best predictors of postoperative pulmonary complications for patients undergoing pulmonary surgery:

A

FEV1 <40% predicted
DLCO <40% predicted
VO2 max <15 mL/kg/min

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2
Q

___________ is indicated when preoperative assessment suggests an increased risk of postoperative pulmonary complications

A

Split lung V/Q function testing

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3
Q

Absolute indications for one-lung ventilation include

A

infection
massive hemorrhage
bronchopleural fistula

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4
Q

Relative indications for one-lung ventilation include

A

improved surgical exposure
pulmonary edema
severe hypoxemia d/t lung disease

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5
Q

Ideal DLT sizing for females is

A

35-37 French

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6
Q

Ideal DLT sizing for males is

A

39-41 French

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7
Q

DLTs should not be used for

A

children under 8 years of age

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8
Q

Options for OLV in children under 8 include

A

a bronchial blocker or single lumen tube advanced into the main bronchus

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9
Q

Double-lumen ETTs can be

A

left or right sided

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10
Q

A __________ double-lumen is typically preferred

A

left

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11
Q

A right-sided DLT may be best in the following situations:

A

left main bronchus has distorted anatomy (tumor, TAA)
surgical procedures including left pneumonectomy, left lung transplant or left sleeve resection

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12
Q

Tests for pulmonary surgery address these 3 things:

A

lung parenchymal function (gas exchange)
respiratory mechanics (airflow)
cardiopulmonary reserve

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13
Q

A 35 french tube is indicated for

A

females <160 cm

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14
Q

A 37 French tube is indicated for

A

females >160 cm

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15
Q

Insertion depth of a DLT for females is

A

27 cm

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16
Q

A 39 French tube is indicated for

A

males <170 cm

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17
Q

A 41 French tube is indicated for

A

males >170 cm

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18
Q

Insertion depth of a DLT for males is

A

29 cm

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19
Q

The best size DLT for an 8 year old is

A

26 French

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20
Q

The best size DLT for 10 years old and up is

A

28-32 French

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21
Q

During anesthesia in the lateral decubitus position, the non-dependent lung is

A

better ventilated and the dependent lung is better perfused (V/Q mismatch)

22
Q

During one-lung ventilation, there’s a mixing of blood from the non-dependent (non-ventilated) lung and the dependent (ventilated) lung, this leads to

A

increased shunt fraction and is a significant source of hypoxemia

23
Q

Suggestions for initiating OLV include:

A

FiO2 100%
Vt: 6-8 mL/kg IBW
RR: 12-15 breaths/min.
ARM before starting OLV
assess serial ABGs after OLV is started
Consider PEEP 5-10 cmH2O
adjust the I:E ratio if the pt. has an expiratory air flow limitation
Consider TIVA vs. volatile anesthetic

24
Q

Stepwise approach to hypoxemia during OLV:

A
  1. verify delivery of 100% oxygen
  2. check the position of tube/bronchial blocker via fiberoptic bronchoscopy
  3. R/o physiologic causes of hypoxemia, such as reduced CO, bronchospasm, mucus plug, pneumothorax
  4. Apply CPAP to the non-dependent lung or use a suction catheter to insufflate O2
  5. Apply PEEP 5-10 cmH2o to dependent lung
25
Q

If the stepwise approach to hypoxemia for OLV didn’t work, the options include

A

intermittently reinflate the non-dependent lung
ligate the pulmonary artery
eliminate drugs that inhibit hypoxic pulmonary vasoconstriction

26
Q

If the DLT is in too far, the

A

upper lobe is not ventilated (increased risk of hypoxemia)

27
Q

If the DLT is not deep enough,

A

there will be failure to achieve lung separation

28
Q

If the DLT is in the wrong bronchus, the

A

wrong lung collapses

29
Q

Is hypoxemia during OLV more common during surgery on the right or left lung?

A

right lung- the left lung is smaller than the right so there’s less surface area for gas exchange when the left lung is ventilated (during right lung surgery)

30
Q

Unlike a DLT, the bronchial blocker CANNOT (select 3):
a. insufflate oxygen into the isolated lung
b. ventilate the isolated lung c. provide lung separation in the patient requiring nasotracheal intubation
d. prevent contamination from contralateral lung infection
e. provide lung separation in children
f. suction secretions from the isolated lung

A

b. ventilate the isolated lung
d. prevent contamination from contralateral lung infection
f. suction secretions from the isolated lung

31
Q

A bronchial blocker placed through

A

a single lumen endotracheal tube is an alternative method of providing OVL

32
Q

An advantage of the bronchial blocker is that the patient won’t need

A

to be reintubated with a single lumen ETT if he requires postoperative ventilation

33
Q

Downsides of a bronchial blocker include

A

the operative lung is slow to collapse (b/c the lumen of the BB is narrow)
high-pressure balloon can easily slip to enter the trachea which can lead to contamination and even block ventilation of both lungs

34
Q

Examples of why you would use a bronchial blocker instead of a DLT include:

A

children <8 years old
patient requires nasotracheal intubation
patient has a tracheostomy
there’s already a SL ETT in place
patient requires intubation after surgery & want to avoid changing the DLT

35
Q

Several types of bronchial blockers include

A

EZ
Cohen
Arndt
Uniblocker

36
Q

Identify the MOST common serious complications of mediastinoscopy (select 2):
a. chylothorax
b. pneumothorax
c. left recurrent laryngeal nerve injury
d. hemorrhage

A

b. pneumothorax
d. hemorrhage

37
Q

Mediastinoscopy is performed to

A

diagnose and stage lung cancer

38
Q

The most common serious complications of mediastinoscopy include

A

hemorrhage (#1) & pneumothorax (#2)

39
Q

An absolute contraindication to mediastinoscopy is

A

previous mediastinoscopy (d/t scarring)

40
Q

Since hemorrhage is a risk with mediastinoscopy, it is necessary to have

A

large bore IV access and PRBCs available

41
Q

Compression of the innominate artery with mediastinoscopy can

A

impair cerebral perfusion (right side of the circle of Willis)

42
Q

Where you place your monitors is important for monitoring

A

compression of the innominate artery
pulse oximeter & arterial line on RUE

43
Q

If the scope compresses the innominate artery, the

A

waveform of the pulse ox or arterial line will dampen or disappear

44
Q

There is an association between oat cell carcinoma and

A

Eaton-Lambert syndrome

45
Q

Patients with Eaton-Lambert syndrome are sensitive to

A

both succinylcholine and non-depolarizers

46
Q

Indications for tracheal resection include

A

tracheal stenosis
tracheomalacia
tumor
vascular lesions
congenital malformations

47
Q

To reduce tension on the tracheal anastomosis, the patient’s

A

neck must maintain a flexed position for several days after surgery

48
Q

The best choice if a patient needs to be reintubated postoperatively after a tracheal anastomosis is

A

flexible fiberoptic bronchoscopy

49
Q

Vital structures at risk for injury during mediastinoscopy include

A

thoracic aorta (hemorrhage and reflex bradycardia)
innominate artery (decreased carotid & cerebral blood flow)
vena cava (hemorrhage)
trachea (airway obstruction)
thoracic duct (chylothorax)
phrenic and recurrent laryngeal nerve (paresis)

50
Q

Relative contraindications to mediastinoscopy include

A

tracheal deviation
thoracic aortic aneurysm
superior vena cava obstruction

51
Q

A complication of neck hyperflexion is

A

tetraplegia

Apex Review (224 decks)

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