Thoracic Anesthesia Part 1 Flashcards
(33 cards)
- Leading cause of cancer deaths?
- ___% of all cancer
- ___% of all cancer deaths
- Categorized as (2)
- ___ new cases in US a year, 1.2 million worldwide
- Lung cancer
- 15%
- 28%
- Small cell carcinoma and non-small cell carcinoma
- 200,000
Poor prognosis, metastatic, 3 month survival after diagnosis?
*Tumor of ____ origin (2)
(Can secrete ectopic hormones mostly ___ and ___)
Small cell carcinoma
*neuroendocrine origin
Lambert Easton Myasthenic syndrome, SIADH
(ACTH and ADH)
Linked to cigarette smoking, prognosis variable, 75-80% of all primary lung cancers?
- ___ CONSIDERED in all patients
- Less than 50% survive ____
Non-small cell carcinoma
- surgery
- 5 years
Preop = Tumor Staging (tumor size, nodal involvement, metastasis) 0 = \_\_\_ 1 = \_\_\_ 2 = \_\_\_ 3 = \_\_\_ 4 = \_\_\_
0 = in situ 1 = localized to tissue 2 = spread to lymph nodes close by 3 = more extensive lymph node involvement 4 = spread to other distal tissues and organs
Symptoms from tumor may occur in one or more category:
1) ___ = involve lung; cough, dyspnea
2) ___ = tumor growth beyond confines of the lung; pleural effusion, chest wall pain, dysphagia
3) ___ = tumor spread outside the thorax; brain, skeletal, kidney
4) ___ = Paraneoplastic syndrome: endocrine or endocrine like syndrome; cushings disease, hypercalcemia
5) ___ = weight loss, anorexia, anemia, malaise, vague cold-like syx
1) Bronchopulmonary
2) Extrapulmonary Intrathoracic
3) Extrathoracic Metastatic
4) Extrathoracic Non-metastatic
5) Nonspecific
Answer the question of “How operational or functional will the remaining lung be after resection?”
PFTs
*Major factor associated with postop pulmonary problems?
- These 2 patients definitely need PFTs preoperatively??
- PFTs identify patients with?
- Preexisting lung dysfunction
- Thoracic surgery candidates, patients over the age of 70
- abnormal lung function
First test they do? Deep maximal inspiration followed by maximal expiration
- Most common measurement of ?
- Values vary with ___ and ___.
- Normal is ___ predicted value for height and age.
- VC decreased by (4)
Vital Capacity
- lung function
- height and age
- > /= 80%
- going from sitting to supine position, restrictive lung disease, loss of distensible lung tissue, max inspiration or exhalation not achieved
- Reflects flow resistance in the airway?
- ___ measured in ___ and must not be interrupted by (3)
- Forced vital capacity (max inspiration followed by rapid forceful expiration)
- Exhalation
- time
- cough, closure of glottis, mechanical obstruction
Whole Lung Testing/Phase 1 Testing: 2 components
- Detect abnormalities of ___
- Detect abnormalities of the (3)
- gas exchange
- lung
- chest wall
- mechanical aspects of ventilation
- ___ is reduced by the same conditions that decrease VC
- ___ = forced expiratory volume in the first second of the FVC measurement (3 Spirograms and best FEV1 and best FVC recorded to make the ratio)
- Normal FEV1/FVC ratio is?
- FVC
- FEV1
- 75-80% or above
These 2 can help to determine postop outcome??
FEV1 and maximum ventilatory ventilation
Largest volume that can be breathed per minute by voluntary effort?
**requires high rate of ___, changes in ___ will alter this
Maximum ventilatory ventilation
- *air flow
- *airway resistance
MVV is reduced in ?
MVV correlates with ? (Equation?)
Obstructive disease
FEV1
(FEV1 X 35 = ~MVV)
- FVC only normal in ___
* FEV1/FVC ratio only decreased in ___
*Obstructive disease
(decreased in restrictive and muscle weakness)
*Obstructive disease
Factors affecting ___*
-Patient effort, elastic properties of the lung, chest wall abnormalities, respiratory muscle strength
Maximum ventilatory ventilation
- Closing volume = the lung volumes at which airways begin to close or stop contributing to the expired gas
- In the sitting position CV for healthy individuals is?
- Elevated in ___!!! (Reflects loss of ___ or ___)
- 15-20% of VC
- Smokers!!!
- loss of elastic recoil and/or small airway pathology
- ___ = ability of the lung to perform gas exchange (inhale CO and tested)
- ___ of postop predicted value is high risk
- Diffusing Capacity
- less than 40 percent
- ___ = Maximum oxygen consumption during exercise testing
- Decrease of ___ during exercise testing is considered high risk
- Preop ___ = high risk
- VO2max
- 4%
- Preop VO2max of less than 15 ml/kg/min
2 additional tests predictive of postop outcome?
Diffusing capacity and VO2max
Increased operative risk if (4)
1) ABG shows hypercapnia on room air
2) FEV1 less than 50% of FVC
3) FEV1 less than 2 liters
4) RV/TLC >50%
Phase 3 Testing: Can’t tolerate procedure if….
- PAP = ___
- PaCO2 = ___
- PaO2 = ___
- PAP >40 mmHg
- PaCO2 >60 mmHg
- PaO2 less than 45
- Second most common cause of periop M&M?
- Biggest issue with COPD patients is ? (They can’t tolerate increases in their ___, on oxygen at home)
- Cardiac complications
- right sided heart failure (RV hypertrophy and dilation)
- afterload
Prevention of arrhythmias: Drug Prophylaxis (4)
Amiodarone
Diltiazem (most common)
Digoxin
Beta blockers
