Week 13 Handout Flipped Classrooms: OBSTRUCTIVE DISEASES & RLD

Question 1

What is the screening tool for Obstructive Sleep Apnea (OSA)?

Answer 1

Use the STOP-BANG assessment: Snoring, Tiredness during the day, Observed apnea, Pressure (HTN), BMI > 35 kg/m², Age > 50, Neck circumference > 40 cm, Gender (male)

Question 2

What are the key risk factors for OSA?

Answer 2

Obesity, male sex, large neck circumference, untreated or poorly controlled OSA

Question 3

What is the plan for airway management in OSA?

Answer 3

High suspicion for difficult mask ventilation and intubation. Confirm whether patient uses CPAP/BiPAP at home.

Question 4

What are intraoperative airway risks for OSA?

Answer 4

Redundant pharyngeal tissue and upper airway collapse risk. Difficult mask ventilation and laryngoscopy may occur.

Question 5

What is the CNS depressant sensitivity in OSA patients?

Answer 5

Increased sensitivity to opioids, benzodiazepines, and inhaled agents. Prefer short-acting drugs and opioid-sparing techniques.

Question 6

What are the extubation criteria for OSA patients?

Answer 6

Only extubate when patient is fully awake and responsive. Ensure full return of airway tone and protective reflexes.

Question 7

What are the postoperative respiratory monitoring considerations for OSA?

Answer 7

Increased risk of post-extubation apnea or desaturation. Requires prolonged PACU monitoring or admission to a monitored bed.

Question 8

What are the disposition concerns for OSA patients postoperatively?

Answer 8

May not qualify for same-day discharge. Must have access to their CPAP/BiPAP (encourage them to bring it to surgery).

Question 9

What should be avoided in postoperative medications for OSA?

Answer 9

Avoid sedating meds post-op: If needed, use lowest effective dose and monitor closely.

Question 10

What should be assessed for COPD preoperatively?

Answer 10

History of recent exacerbations, cough, sputum production, dyspnea. Determine baseline function (e.g., exercise tolerance).

Question 11

What tools are used to classify COPD severity?

Answer 11

GOLD Classification (based on FEV₁ % predicted) and BODE Index (BMI, Obstruction, Dyspnea, Exercise capacity).

Question 12

What is the goal for optimizing lung function in COPD?

Answer 12

Pre-op bronchodilator therapy (inhalers or nebulizers). Delay elective surgery during acute exacerbations.

Question 13

What should be avoided regarding anesthesia in COPD?

Answer 13

Avoid neuraxial anesthesia at high levels, nitrous oxide, and use volatile agents cautiously.

Question 14

What are the ventilation management goals for COPD?

Answer 14

Prevent air trapping, low tidal volumes, avoid high peak inspiratory pressures, use PEEP cautiously.

Question 15

What are the postoperative considerations for COPD?

Answer 15

May require continued intubation and mechanical ventilation, especially after thoracic or upper abdominal surgery.

Question 16

What should be evaluated for asthma preoperatively?

Answer 16

Evaluate asthma control before surgery/red flags: Frequent inhaler use, recent ER visits, nocturnal awakenings, recent increases in medication requirements, signs of upper respiratory tract infection.

Question 17

What is the goal for intraoperative management of asthma?

Answer 17

Prevent airway reactivity and bronchospasm.

Question 18

What are the preferred induction agents for asthma?

Answer 18

Propofol, Ketamine, Sevoflurane.

Question 19

What should be avoided in asthma management?

Answer 19

Desflurane, isoflurane, morphine, atracurium, mivacurium, non-selective beta blockers, prostaglandins, and ergonovine.

Question 20

What are the ventilation risks in asthma?

Answer 20

Air trapping, hyperinflation leading to decreased venous return and cardiac output.

Question 21

What are the primary preoperative considerations for pulmonary hypertension (PH)?

Answer 21

Continue all PAH medications, assess ECG, Echo, ABG, and Chest X-ray.

Question 22

What are the primary goals during intraoperative management of PH?

Answer 22

Avoid increased pulmonary vascular resistance (PVR) and decreased systemic vascular resistance (SVR).

Question 23

What should be avoided in the management of pulmonary hypertension?

Answer 23

Hypoxemia, hypercarbia, acidosis, hypothermia, pain, ketamine, nitrous oxide, and desflurane.

Question 24

What is the preferred induction agent for pulmonary hypertension?

Answer 24

Etomidate for induction – minimal cardiac depression.

Question 25

What monitoring is recommended for pulmonary hypertension?

Answer 25

Arterial line recommended, consider CVP or PA catheter if severe PH.

Question 26

What should be done in case of hypotension in PH patients?

Answer 26

Use vasopressors if decreased SVR, inhaled nitric oxide, iloprost, and fluid cautiously if RV failure.

Question 27

What are early signs of acute pulmonary embolism (PE)?

Answer 27

Tachycardia, sudden decrease in ETCO₂ waveform and value, moderate hypoxemia without CO₂ retention.

Question 28

What are advanced signs of acute pulmonary embolism (PE)?

Answer 28

Hypotension, rapid rise in PAP and CVP (if monitored), ECG changes (sinus tachycardia, RBBB, S1Q3T3 pattern).

Question 29

What indicators suggest a massive pulmonary embolism (PE)?

Answer 29

Sudden hypotension, severe tachycardia, loss of ETCO₂, may progress to cardiac arrest.

Question 30

What is the first line treatment for hypotension in acute PE?

Answer 30

Norepinephrine.

Question 31

What are the intraoperative management steps for acute PE?

Answer 31

Secure airway with 100% FiO₂, support circulatory volume with IVF or blood, manage ventricular dysrhythmias with lidocaine or amiodarone, and provide adequate PEEP.

Question 32

What are common causes of bronchospasm?

Answer 32

Airway manipulation, surgical stress (especially in asthma patients), allergic reactions, histamine-releasing agents (e.g., morphine, atracurium, mivacurium).

Question 33

What are signs and symptoms of bronchospasm?

Answer 33

Diffuse wheezing, increased peak inspiratory pressure (PIP), decreased tidal volumes, shark-fin ETCO₂ waveform, hypoxemia, increased mucous production.

Question 34

What is the first step in the treatment approach for bronchospasm?

Answer 34

Deepen anesthesia using agents like sevoflurane, propofol, ketamine, or IV lidocaine.

Question 35

What should be done to maximize alveolar oxygenation in bronchospasm?

Answer 35

Increase FiO₂ by delivering 100% oxygen immediately.

Question 36

What is the role of beta-2 agonists in bronchospasm treatment?

Answer 36

Administer short-acting inhaled beta-agonists (e.g., albuterol).

Question 37

When should epinephrine be administered for bronchospasm?

Answer 37

For moderate to severe bronchospasm, especially if progressing toward anaphylaxis.

Question 38

What corticosteroids can be used to reduce inflammation in bronchospasm?

Answer 38

Methylprednisolone and dexamethasone.

Question 39

What post-bronchospasm considerations should be taken?

Answer 39

Delay extubation until airway reactivity has subsided, ensure complete resolution of wheezing, monitor for recurrence in PACU, and consider post-op bronchodilator therapy or ICU monitoring.

Question 40

What is Restrictive Lung Disease (RLD)?

Answer 40

RLD refers to conditions that impair the ability of the lungs to fully expand during inspiration.

Question 41

How is Restrictive Lung Disease characterized?

Answer 41

It is characterized by a reduced Total Lung Capacity (TLC < 5th percentile).

Question 42

What causes Restrictive Lung Disease?

Answer 42

It is caused by increased stiffness or tightness of the lungs, pleura, chest wall, or neuromuscular apparatus.

Question 43

What are the results of Restrictive Lung Disease?

Answer 43

It results in decreased lung volume & capacity, reduced compliance, and impaired gas exchange.

Question 44

What are the types of Restrictive Lung Disease?

Answer 44

The types are Intrinsic RLD, Extrinsic RLD, and Neuromuscular RLD.

Question 45

What is Intrinsic RLD?

Answer 45

Intrinsic RLD refers to diseases directly affecting the lung interstitium.

Question 46

What are examples of Intrinsic RLD?

Answer 46

Examples include Pneumoconiosis, Sarcoidosis, and Pneumonitis.

Question 47

What is Extrinsic RLD?

Answer 47

Extrinsic RLD refers to impaired lung expansion due to external restriction.

Question 48

What are examples of Extrinsic RLD?

Answer 48

Examples include Obesity, Flail chest, Scoliosis, Pneumothorax, and Ankylosing spondylitis.

Question 49

What is Neuromuscular RLD?

Answer 49

Neuromuscular RLD is inadequate chest wall movement due to muscle or nerve disorders.

Question 50

What are examples of Neuromuscular RLD?

Answer 50

Examples include Myasthenia gravis, Guillain-Barré syndrome, and Poliomyelitis.

Question 51

What is Pneumoconiosis?

Answer 51

Pneumoconiosis is a lung disease caused by inhalation of airborne dust/fibers.

Question 52

What are the subtypes of Pneumoconiosis?

Answer 52

Subtypes include Asbestosis, Silicosis, and Coal worker’s pneumoconiosis.

Question 53

What is Sarcoidosis?

Answer 53

Sarcoidosis is a multisystem granulomatous disease formed by activated macrophages & lymphocytes.

Question 54

What ethnic variation is noted in Sarcoidosis?

Answer 54

It is more common and severe in Black populations.

Question 55

What is Pneumonitis?

Answer 55

Pneumonitis is inflammation of lung tissue of noninfectious origin.

Question 56

What triggers Pneumonitis?

Answer 56

It is triggered by irritants, allergens, radiation, or medications.

Question 57

What is Acute Intrinsic RLD: ARDS?

Answer 57

ARDS is caused by severe inflammation of the alveolar-capillary membrane.

Question 58

What triggers ARDS?

Answer 58

It is triggered by cytokine storm, phospholipids, and immune activation.

Question 59

What is Extrinsic RLD: Flail Chest?

Answer 59

Flail chest is chest wall trauma from multiple rib fractures causing paradoxical breathing.

Question 60

What is Extrinsic RLD: Pneumothorax?

Answer 60

Pneumothorax is air in the pleural space causing partial or complete lung collapse.

Question 61

What are the severity classifications of Pneumothorax?

Answer 61

Small: ≤15% collapse, Moderate: 15–60% collapse, Large: >60% collapse.

Question 62

What are preoperative anesthetic considerations for RLD?

Answer 62

Perform thorough pulmonary evaluation, optimize comorbid conditions, and encourage pre-op pulmonary rehab.

Question 63

What are intraoperative anesthetic considerations for RLD?

Answer 63

Prefer regional anesthesia, minimize sedation, and use lung-protective ventilation.

Question 64

What should be monitored intraoperatively for RLD?

Answer 64

Monitor for hypoxia, CO₂ retention, and increased airway pressures.

Question 65

What are postoperative anesthetic considerations for RLD?

Answer 65

Implement aggressive pulmonary hygiene, encourage early mobilization, and monitor for atelectasis.