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Principles III > Thoracic sx (final) Endoscopy procedures ppt. Newby > Flashcards

Thoracic sx (final) Endoscopy procedures ppt. Newby Flashcards

I have nothing bad to say about Boyd and his arms he is leaving us : ( sad face.... I hope it's not windy his last day.. or he won't be able to wave goodbye to us : (

1
Q

what are some basic disease states that may require thoracic sx

A
  • Lung Tumors
  • esophageal Disease
  • mediastinal Tumors
  • Infection
  • Bronchiectsis
  • Thoracic aneurysms
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2
Q

Thoracic sx

so what are 2 main endoscopy procedures?

A
  • Bronchoscopy
  • esophagoscopy
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3
Q

Thoracic sx:

what are 2 mediastinal procedures

A
  1. mediastinoscopy
  2. Thymectomy (not an endoscopic procedure)
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4
Q

Monitoring for endoscopic sx:

what monitors do you need nood endoscopy procedures

A
  • all standard monitors
  • Radial A-line
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5
Q

Monitoring for endoscopic sx:

what do you want to consider then doing an A-line for these procedures?

A
  • Left vs Right A-line
  • lateral decubitus position A-line in dependent arm (AKA the arm on the bottom)
  • Mediastinoscopy- A-line in Left arm (b/c innominante artery)

(so if you are confused on lateral decubitus here is how I remember it- Decubitus- comes from the latin word “decumber” ( i am pretty sure lol) meaning lying down or to lie down. thus right lateral decubitus means “to lie down on right side”)

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6
Q

Endoscopy: Anesthesia

how is flexible bronchoscopy performed?

A

MAC

or

GETA

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7
Q

Endoscopy: Anesthesia

how are Rigid Bronchoscopy performed

A

GETA

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8
Q

Endoscopy: Anesthesia

what are some concerns with Rigid Bronchoscopy prodecures (for you the anesthesia provider)

A
  • Hypercapnea
  • Hypoxemia
  • Air leaks
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9
Q

Endoscopy: Anesthesia

what are ways to ventilate a pt whle a rigid bronchoscopy is being performed?

A
  • Anesthesia machine vs Jet ventilation
  • Side arm ventilation port
  • Sanders Bronchoscopes ( ventiri effect w/ jet vent)
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10
Q

Endoscopy Procedure:

what are complications?

A
  • Facial, dental, laryngeal injury
  • Airway rupture
  • pneumothorax
  • hemorrhage
  • Airway obstruction
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11
Q

Endoscopy Procedure:

what things may cause airway obstructions?

A
  • Blood
  • FB
  • Edema
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12
Q

Endoscopy Procedure:

what are some anesthesia considerations

A
  • Small ETT vd Double lumen tube
  • Laser tube and Laser precautions
  • Short acting hypnotics
  • Inhaled vs TIVA anesthesia
  • Short acting Narcs
  • Short acting Muscular relaxants
  • Local anesthesia (post-op)
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13
Q

Endoscopy Procedure:

if using a SCh gtt or multiple doses od SCh what may occur? and what should you do?

A
  • Bradycardia (treat if needed)
  • Phase II block ( do nothing who gives a shit it’s cool)
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14
Q

What type of approach are these

A
  1. Cervical
  2. Anterior
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15
Q

Mediastinal Procedures:

what do we discover performing an upright and Supine PFT’s? and why do we do this?

A
  • If PFT normal upright then decreased when laying down then we know they have a restrictive disease
  • and we can identify AIRWAY risk
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16
Q

Mediastinal Procedures:

so after performing Upright and Supine PFTs we discover the pt has a poor supine PFT… besides an airway risk why do we give a shit? basically what airway risk can occur and how will we provoke that? how can you treat it?

A
  • if you have a pt with a poor supine PFT and give NMBD and VAA you may not be able to ventilate them.
  • This is due to the compression of airway do to changes in pressures and muscle loss in the intercostals
  • Treatment is performed by sitting up and restoring spontaneous ventilation and normal intrathoracic pressures
17
Q

Mediastinal Procedures:

so if a pt does have poor Supine PFTs (which most will thus the reason they are probally having the sx) what drugs to we want to use of induction and why? (r/t NMBD)

A
  • with or without SCh (if using just use a little)
  • there is really no need for SCh to intubate, we only use it to gain a better view for double lumen tube placement
18
Q

Mediastinal Procedures:

what are the complications?

A
  • # 1- rupture/Laceration to major vessels
  • # 2 Pneumo (Hemo)- thorax
  • intermittent occlusion of Right innominate artery (thats why A-line is on the Left)
  • Tracheal collaps
  • Tension pneumomediastinum
  • mediastinitis
  • chylothorax
19
Q

Mediastinal Procedures:

what 3 main procedures require a median sternotomy?

A
  • thymectomy
  • mediastinal masses
  • Bilateral Pulmonary resecrtion
20
Q

Mediastinal Procedures:

what is the treatment of choice for myasthenia Gravis?

A

Thymectomy

(just for knowledge- sternal incision or cervical appraoach)

21
Q

Myasthenia Gravis:

is an autoimmune disease that effect the __________ ACh receptors?

A

post junctional

22
Q

Myasthenia Gravis:

is more prevalent in what sex

A

females

1:20,000

23
Q

Myasthenia Gravis:

10% of MG pts develop what?

A

thymomas

(from ACh-antibodies)

24
Q

Myasthenia Gravis:

is characterized by what? (What are the bascic S/S)

A
  • Occular, pharyngeal, and skeletal- muscle weakness
25
Q

Myasthenia Gravis:

treatment

A
  • anticholinesterases
  • corticosteroids
  • immuniosupressents
  • plasmapheresis
  • thymectomy
26
Q

Myasthenia Gravis: Anesthetic Considerations:

what about home meds?

A

hold anticholinesterase meds day of sx (continue up until that day)

27
Q

Myasthenia Gravis: Anesthetic Considerations:

muscle relaxants?

A

(+++) NDMR and (–) DMR

  • effects based on therapy
28
Q

Myasthenia Gravis:

what is an associated disease that involes the PRE-junctional decreased ACh release?

A

Eaton-Lambert Syndrome

29
Q

Myasthenia Gravis:

is there inprovement with Anticholinesterases with Eaton-Lambert Syndrome

A

nope

30
Q

Myasthenia Gravis: Eaton-Lambert Syndrome

what is the underyling problem?

A

SCCa of the lung

31
Q

Myasthenia Gravis: Eaton-Lambert Syndrome

which muscle are most affected with this d/o?

A

peripheral muscles and pelvis

32
Q

Myasthenia Gravis: Eaton-Lambert Syndrome

symptoms improves with _______ and weakens after

A

Exertion

33
Q

Myasthenia Gravis: Eaton-Lambert Syndrome

muscle relaxation choice for the D/O?

A

(+++) NDMR and DMR

34
Q

Mediastinal Masses: Anesthesia Considerations

what do you want to consider prior to putting these pt’s asleep? (specicif to repiratory system)

A
  • Degree of functional impairment
  • Orthopnea
  • Supine and Upright PFTs
35
Q

Mediastinal Masses: Anesthesia Considerations

other considerations

A
  • Specific Ct report/reexamination
  • Close communication with sx
36
Q

Mediastinal Masses: Anesthesia Considerations

what is DYNAMIC AIRWAY OBSTRUCTION?

A
  • position/muscle tension dependent
  • Fine with upright/ spont vent; DEAD with supine and reaxed
  • Cant ventilate even with properly placed ETT
37
Q

Mediastinal Masses: Anesthesia Considerations

what is treatment for DYNAMIC AIRWAY OBSTRUCTION?

A
  • rigid Bronch (emergent)
  • Positin change
  • Sponteous ventilation

Principles III (24 decks)

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