Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Principles semester 2 > Thoracic Sugery > Flashcards

Thoracic Sugery Flashcards

(74 cards)

Start Studying
1
Q

Smoking cessation 2 motns

A

bronchial secretions increase = risk of complications

however, with advanced lung cancer patients can’t wait 2 months for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What PFTs are needed for thoracic surgery to predict postoperative risk?

A

PPO FEV1 - calculates current FEV1 multiplied by the fraction of functioning lung

and DLCO

Traditional FEV1 is not enough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

DLCO

A

diffusion capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

DLCO (diffusion capacity)

A

measures the lung’s ability to transport gas across the alveolar capillary membrane

pt holds breath of CO for 10 seconds, then exhales. Measure meant of exhaled CO is calculated with predicted values

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What DLCO increases complicaion risk?

A

<60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Normal DLCO

A

17-25 mL/min/mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Predicted postoperative product is

A

FEV1 multipled by DLCO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

VO2 max

A

max O2 consumption during exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

VO2 low posoperative risk

A

> 20 mL/kg/min

can climb 5 flights of stairs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

VO2 high postperative risk death

A

<10 mL/kg/min

cannot climb one flight of stairs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

V/Q tests postoperative risk (how?)

A

Radioisotope IV dye shoes perfusion to all areas of lung - calculations can be made to determine pulmonary function once diseased areas are removed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Post operative complications ABGs and SPO2

A

SpO2 <90% is indicative of post-op complications

PaCO2 is indicative of poor ventilatory function but not post op complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

EKG high postoperative complication risk

A

RV hypertrophy - low QRS and poor R wave progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cancer risk factors

A

4 M’s (lung damage/poor lung funtion)
mass effects
metabolic effects
metastases
medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What PPO FEV1 warrants further testing preoperatively?

A

PPO FEV1 < 40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What should be checked if PPO FEV1 is < 40%?

A

DLCO
V/Q scan
VO2 max

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

High risk candidates FEV1

A

<2L or <40% of predicted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Oxygen desaturation high risk

A

> 4% during exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pulmonary artery catheter monitoring will not be accurate if

A

surgery on the right lung and is collapsed

usually not used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Arterial line placement lateral decubitus

A

Dependent arm for stabilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Arterial line placement during medistinoscopy and why

A

R arm - detects compression of innominate artery - able to identify a decrease in cerebral blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

SPO2 monitor placement for mediastinoscopy

A

R arm - detection of innominate artery compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Normal lung blood flow distribution in lateral position

A

60% to dependent lung, 40% to nondependent lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How does V/Q mismatch occur in lateral decubitus position?

A
  1. FRC is reduced during induction
  2. FRC is further reduced in dependent lung (where perfusion is best) = uneven reduction in FRC–>ventilation increases in nondependent lung

ventilation is not best in dependent lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
V/A mismatch in paralyzed, mechanically ventilated patient
Further reduced FRC (diaphragm no longer counteracting) ventilation goes to nondependent lung even more, but perfusion still better in dependent lung = even more V/Q mismatch
26
Open chest and V/Q mismatch
Open chest reduces resistance in ventilation, so it goes even more to nondependent lung. Mediastinum shifts downward from loss of neg intrapleural pressure in open lung = ventilation of dependent lung decreased even more Creates the largest V/Q mismatch
27
How does OLV help V/Q mismatch
Hypoxic Pulmonary Vasoconstriction - lung is deflated and blood flow diverts to areas of higher PAO2 (better ventilated, nondependent lung)
28
What triggers HPV
alveolar hypoxia NOT arterial hypoxemia
29
Where does HPV take place?
ONLY in proximal pulmonary arteries (in circulation, hypoxemia causes vasodilation)
30
HPV decreases blood flow during OLV by
50%
31
In OLV, the blood flow distribution between lungs is
80:20 (instead of 60:40)
32
What fraction of lung hypoxia causes HPV to yield right ventricular strain?
When 80% of lung is hypoxic, increased PVR causes RV strain and failure
33
What anesthetic factors/events can redcuce HPV?
1. Hypo/hypervolemia 2. Too high Vt or PEEP 3. inhalation agents >1.5 MAC 4. acidosis or alkalosis 5. hyOcapnia 6. HypOthermia 7. vasodilators and vasoconstrictors
34
Absolute indications for OLV
1. isolation from one lung to another (infection or massive hemmorage) 2. Control of distribution of ventilation 3. Unilateral bronchopulmonary lavage
35
Relative indications for OLV
Will lung get in the way of surgery? Ideally OLV, but may not be tolerated
36
Know this list
37
When should you turn ETT 90 deg for OLV
immediately after advancing through cords. Then remove stylet and advance
38
Once throught cords and after removing stylet, how far should you advance ETT for OLV?
27-29 cm
39
Tracheal cuff inflation
5-10mL
40
bronchial cuff inflation
1-3 mL
41
Complication of DLT
bronchial rupture from over-inflating cuff 1-3mL max
42
Complication of Right sided DLT and why
bronchial lumen can obstruct right upper lobe less distance from carina to right upper lobe (2.5 cm compared to 4-5 cm on left) consider using left sided DLT unless there is a contraindication
43
Basic anesthetic considerations in OLV
1. <1.5 MAC 2. No N2O (increases PVR and traps air) 3. avoid long acting NMB (panc) 4. frequently monitor NMB fxn and always reverse
44
Main goal during surgery for anesthesia
Maintain adequate oxygenation while maintaining visualization of lung for the surgeon
45
Ventilator settings for OLV
1. Vt limited to 6mL/kg 2. PEEP only 5-10 3. Reduce FiO2 - absorptive atelectasis 4. avoid hypocapnia (reduces HPV) 5. normal ETCO2 (28-32)
46
Hypoxemia occurance during OLV: what should you do?
1. increase FiO2 2. check for malposition of tube (listen, bronchoscope) 3. differentiate physiologic causes 4. recruitment manevuer, CPAP, PEEP to dependent lung (let surgeon know) 5. Possible early ligation of PA (if this is in the plan) 6. Almitrine to NDL 7. NO to dependent lung
47
Definitive treatment for hypoxemia during OLV
Resume two long ventilation
48
After lung resection, the operative lung is ______. You should
reinflated and checked for air leaks. keep PIP < 30-40
49
Following lung re-expansion _____
deflate bronchial cuff (avoid ischemia to bronchus)
50
Most effective pain control for thoracic surgery
Thoracic epidural T6-T8
51
Thoracic epidural analgesia and HPV
does NOT decrease HPV can use less agent with working epidural
52
Analgesia considerations (thoracic surgery)
1. PCA 2. adjuncts (ketamine) 3. Thoracic epidural * 4. Paravertebral nerve blocks at level of incision plus 1-2 levels above and below 5. cryoanalgesia 6. intrapleural catheter with LA before closure
53
Acute lung injury MOA
reperfusion induces inflammatory mediators at alveolar-endothelial barrier causing leakage of fluid
54
Fluid overload causes
stretching of cappilaries. Disturbs permeability = failure of microvessels
55
Dysrhymias after thoracotomy
1. afib 2. SVT associated with fluids > 2000 mL intraoperatively
56
Basic categories complicatinos after thoracotomy
1. ALI 2. dysrhymias 3. Low CO 4. Increased PVR 5. Respiratory complications 6. Nerve and spinal cord injuries 7. Thoracic duct injury
57
Which side lobectomy is better tolerated and why
Left is better tolerated because R lung is bigger, has more blood flow and oxygenation
58
Nerve injuries that can occur during thoracotomy
1. Phrenic nerve 2. L recurrent laryngeal nerve 3. spinal cord
59
Types of mediastinal masses
4 Ts: 1. thymoma 2. thyroid 3. teratoma 4. "terrible" lymphoma can cause complete collapse
60
Symtoms of mediastinal mass
1. changes in CO 2. Syncope, sweats, orthopnea, superior vena cava obstruction 3. airflow obsturction 4. cough and hoarseness 5. atelectasis 6. CNS changes 7. inability to lie flat
61
Surgical tx/diagnosis of mediastinal masses include:
1. thoracotomy 2. thoracoscopy 3. mediastinoscopy
62
Best plan for medistinal mass OR
1. Locate mass on CT before induction 2. awake fiberoptic 3. spontaneous respiration be sure to have fiberoptic bronchoscope available
63
Complications of mediastinoscotpy
1. hemorrhage 2. pneumothorax 3. innominate arter compression
64
What can occur with compression of innominate arterty
decreased cerebral blood flow
65
Methods of reducing risk of decreased cerebral blood flow d/t compression of innominate artery
1. SPO2 and/or art line on R arm for monitoring 2. NIBP on L arm to avoid interruption of monitoring on R arm
66
Best IV placement for anticipating hemmorage during mediastinocscopy
Large bore in lower extremity in upper, blood given will pass through area of vascular injury and enter mediastinum
67
Absolute contraindciations for mediastinoscopy
previous mediastinoscopy d/t scarring
68
relative contraindications for mediastinoscopy
1. tracheal deviation 2. thoracic aortic aneurysm 3. superior vena cava obsturction
69
Thorascopy management
art line should be placed except in extremely healthy patients
70
What increases bullae and why?
1. PPV increases 2. N2O increases air trapping occurs
71
Bullae complications
1. hypoxemia 2. polycythemia 3. cor pulmonale 4. ruptured bullae can cause pneumothorax and cardiopulmonary collapse
72
Cullae treatment: thoracotomy to resect bullous tissue. What are anesthetic considerations?
1. DLT 2. No N2O 3. spontaneous ventilation is preferred (reduce risk of rupture) 4. Small Vt and increased rate to keep PIP below 10-20 cm H2O 5. jet ventilation
73
Ventilator thoracotomy bullous resection strategies want to keep PIP below ____
1. Small Vt 2. Increased RR In order to keep PIP below 10 - 20
74

Principles semester 2 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions