Thoracic

Question 1

How long is an adult trachea?

Answer 1

11-13cm

Question 2

At what spine does an adult trachea begin?

Answer 2

C6

Question 3

At what angles do the R & L bronchi diverge from the trachea?

Answer 3

R 25, L 45

Question 4

How many lobes does each lung have?

Answer 4

R - 3, L - 2

Question 5

What is the lateral distance of the upper lobes from the carina?

Answer 5

R - 1-2.5cm, L 5cm

Question 6

Which bronchiole is smaller, the one leading to the right middle or right lower?

Answer 6

right lower, is 40:60 diameter split

Question 7

Which are the true ribs? the false ribs? the floating ribs?

Answer 7

true (connect to sternum directly) - 1-7; false (connect to sternum via cartilage or don’t connect at all) - 8-12; floating (don’t connect to sternum) 11-12

Question 8

In one-lung ventilation, which is the dependent lung?

Answer 8

the lung being ventilated

Question 9

What is the ideal patient position during OLV?

Answer 9

lateral with dependent lung on the bottom (so that blood flows to it)

Question 10

What is a normal PaO2?

Answer 10

80-100mmHg

Question 11

What types of airways are available for one-lung ventilation?

Answer 11

DLT, single lumen w/ bronchial blocker, single lumen bronchial tube

Question 12

What size DLT should a patient have?

Answer 12

female: 35 Fr < 63” ht < 37 Fr
male: 37-39 Fr < 67” ht < 41 Fr

Question 13

What is the standard depth (at the teeth) of a DLT?

Answer 13

29cm

Question 14

What are three disadvantages of the single-lumen tube with bronchial blocker?

Answer 14

• blocked lung collapses slowly
• doesn’t allow suctioning or ventilation of isolated lung
• catheter is easily dislodged

Question 15

Which is the isolated lung?

Answer 15

the one not being ventilated

Question 16

Which types of OLV tubes have the potential to cause the most trauma?

Answer 16

Carlen’s (with carinal hook)

Question 17

What is one major advantage of the DLT?

Answer 17

ability to ventilate and suction either lung

Question 18

Which types of OLV tubes can ventilate the isolated lung?

Answer 18

all except bronchial blocker

Question 19

Which OLV tubes have the best success rate of ventilating RUL?

Answer 19

Robertshaw and Carlens because they have a slit in the bronchial cuff

Question 20

What are absolute indications for OLV (3)?

Answer 20

• isolation of spillage or contamination
• bronchopleural fistula
• unilateral bronchopulmonary lavage

Question 21

FEV1/FVC <__% is a high-risk post-op predictor.

Answer 21

50

Question 22

Diffusing capacity <__% is a high-risk post-op predictor.

Answer 22

50

Question 23

RV/TLC >__% is a high-risk post-op predictor.

Answer 23

50

Question 24

PaCO2 >__mmHg is a high-risk post-op predictor

Answer 24

45

Question 25

What does ppo FEV1 stand for?

Answer 25

prediction of post-op fractional expired volume in 1 second

Question 26

How is ppo FEV1 calculated?

Answer 26

pre-op FEV % x (1 - % functional tissue removed/100)

Question 27

What are the percent volumes of each lobe?

Answer 27

RUL 14%, RML 10%, RLL 29%, LUL 24%, LLL 24%

Question 28

What are is one reason why the bottom lung in lateral decubitus would have smaller tidal volumes?

Answer 28

chest wall is constricted by bean bag holding patient in place

Question 29

Under GA, why do tidal volumes decrease for both lungs?

Answer 29

with GA there is an increase in intra-abdominal pressure which decreases diaphragmatic movement

Question 30

In upright or supine position, the right lung receives what percent of TBF?

Answer 30

55%

Question 31

In lateral decubitus, the bottom lung receives what percent of TBF? Why?

Answer 31

60%; shunting (?)

Question 32

What nerves are most likely to be injured during thoracic surgery?

Answer 32

vagus, phrenic, recurrent laryngeal (positioning [lateral] - brachial plexus)

Question 33

HPV is triggered by what sensors? where?

Answer 33

O2 sensors in pulmonary artery smooth muscle cells

Question 34

What anesthetic agents decrease HPV?

Answer 34

inhalationals at >1 MAC, vasodilators (including propofol and etomidate)

Question 35

What notable anesthetic agents have to effect on HPV?

Answer 35

ketamine, morphine, fentanyl

Question 36

How should hypoxemia in OLV be treated?

Answer 36

100% O2; manual ventilation; ventilate at 40mmHg; CPAP 5-10cmH2O to collapsed lung; PEEP to ventilated lung; continuous O2 to collapsed lung; clamp pulm artery of collapsed lung

Question 37

Why is too much PEEP bad in OLV?

Answer 37

Increases shunting of blood to the collapsed lung