Study guide flashcards

Question 1

when dealing with a mediastinal mass what type of intubation should you plan on

Answer 1

fiberoptic, spontaneous respiration

Question 2

cause of leakage in lungs after thoracotomy

Answer 2

inflammatory mediators at alveolar-endothelial barrier

Question 3

ALI - what causes stretching of capillaries?

Answer 3

fluid overload causes failure of micro vessels, disturbing permeability

Question 4

Which side lung lobectomy is better tolerated and why

Answer 4

L lobectomy better tolerated because R lung is bigger and has more blood flow and oxygenation

Question 5

What can occur during mediastinoscopy (besides hemorrhage and pneumo)

how/why?

Answer 5

Pressure on innominate artery–>decreased cerebral blood flow

reduces flow flow to:
R common carotid
R vertebral
Subclavian flow to R arm

Question 6

How do we prevent/monitor for too much pressure on innominant artery

Answer 6

1. Pulse ox and/or art line on R arm
2. BP cuff on L to prevent interruption of R readings

Question 7

In restrictive lung disease, there is a decrease in

Answer 7

All lung volumes and capacities

Question 8

In obstructive lung disease, there is an increase in

Answer 8

RV, FRC, TLC

Question 9

Dominant feature of obstructive lung disease/COPD

Answer 9

progressive airflow obstruction

Increased FRC, RV, TLC

Question 10

What scenario causes the largest VQ mismatch?

Answer 10

Anesthetized, vented, paralyzed, one lung down, open chest

Question 11

HPV is triggered by

Answer 11

alveolar hypoxemia

Question 12

HPV only occurs in

Answer 12

pulmonary circulation

in regular circulation, hypoxemia causes vasodilation

Question 13

HPV in OLV decreases blood flow by (amount)

Answer 13

50%

Question 14

Blood flow in HPV (lung ratio)

Answer 14

80:20 instead of 60:40

Question 15

Potential complicatino with inflating bronchial cuff

Answer 15

bronchial rupture form overinflation

1-3 mL of air in bronchial cuff

Question 16

Bronchial lumen and RUL

Answer 16

Can obstruct more easily:

Carina to RUL: 2.5 cm compared to
Carina to LUL: 4-5 cm

consider using L DLT for R and L deflations unless there is a contraindication

Question 17

Main anesthetic goal in OLV

Answer 17

maintain adequate oxygenation. wile maintaining visualization of lungs for surgeon

Question 18

Hypoxemia in OLV

Answer 18

1. 100% FiO2
2. check tube placement
3. CPAP
4. PEEP
5. Early PA ligation (if planned)
6. resume 2 lung ventilation

Question 19

Following re-expansion of lung, be sure to

Answer 19

deflate bronchial cuff - avoids bronchial ischemia

Question 20

PA catheter and R lung collapse

Answer 20

PA will not give accurate readings

Question 21

Monitor placement for OLV

Answer 21

1. art line on dependent arm for stabilization
2. BP cuff on non-dependent arm to avoid interruption

Question 22

Thoracic surgery pt optimization best:

Answer 22

Cessation of smoking

Question 23

Within 2 months of cessation of smoking:

Answer 23

increased secretions –> increased complications

but patients with lung cancer should not wait longer than 2 months

Question 24

Assessing risk for thoracic surgery PFTs

Answer 24

Need PPO FEV1 (predicted post op FEV1)

traditional FEV1 is not enough

calculates traditional FEV1 by fraction of functioning lung or DLCO

Question 25

Diffusion capacity abbreviation

Answer 25

DLCO

Question 26

DLCO - what does it do

howcan in indicated complications

Answer 26

measures ability to transport gas across alveolar-capillary membrane

<60% = increased complications

Question 27

ABGs and predicting post op complications

Answer 27

SpO2 < 90% on RA is indicative of postop complication

Question 28

IF PPO FEV1 is <40%:

Answer 28

additional screening is needed

DLCO
V/Q scan
VO2 max

Question 29

What do high risk candidates look like for thoracic surgery:

FEV1
PPO FEV1
DLCO
VO2 max
Stairs
Oxygen desaturation

Answer 29

FEV1: <2L or < 40% predicted
PPO FEV1: <40%
DLCO: <40% predicted
VO2 max: < 10 mL/kg/min
Stairs: inability to climb one flight of stairs
O2 sats: desaturation >4% during exercise

Question 30

Most effective analgesia for thoracic surgery:

Answer 30

Thoracic epidural T6 - T8

*does not decrease HPV

Question 31

What increases bullae?

Answer 31

1. N2O
   2.PPV

Question 32

Vt and rate with bullae

PIP gal

Answer 32

small Vt and faster RR

goal to keep PIP below 10-20 cm H2O

Question 33

PIP goal with bullae

Answer 33

below 10-20 cm H2O