Anesthesia For Patients With Respiratory Disease

Front 1

What are the six risk factors that put patient at risk for post op pulmonary dysfunction, most common post op complication?

Back 1

Pre-existing pulmonary disease
Thoracic and upper abdominal surgery
Smoking
Obesity
Age > 60 years
Prolonged general anesthesia > 3hours

Front 2

What are the two strongest predictors of complications?

Back 2

Operative site and duration of procedure

Front 3

What test shows abnormalities early before symptoms of COPD occurs?

Back 3

Maximal midexpiratory flow

Front 4

What kind of changes occurs on obese individuals?

Back 4

Decreased FRC, increased work of breathing, higher risk of DVTs

Front 5

What kind of changes occurs with upper abdominal surgery?

Back 5

Rapid shallow breathing, decreased sighs, ineffective cough due to pain, impaired mucociliary clearance, microatelecstasis

Front 6

What problems occur with intrapulmonary shunting?

Back 6

Hypoxemia

Front 7

What can occur from atelecstasis and mucous or secretory retention?

Back 7

Increased risk of pneumonia

Front 8

What are some obstructive lung diseases?

Back 8

Asthma, COPD, cystic fibrosis, bronchiectasis, bronchiolitis

Front 9

What is the primary characteristic of obstructive lung disease

Back 9

Resistance to airflow

Front 10

What happens to the MMEF of patients with obstructive lung disease?

Back 10

Decreased to less than 70% or <70%

Front 11

What occurs primarily to the FEV1 of patients with obstructive disease?

Back 11

The have a FEV1 is less than 70% of the predicted value

Front 12

What occurs to the increased airway resistance in obstructive disease?

Back 12

Increased air trapping, residual volume and total lung capacity increase

Front 13

What are some of the physical characteristics of Asthma?

Back 13

Episodic dyspnea, cough, wheezing

Front 14

How is airway affected in asthma?

Back 14

Bronchial smooth muscle constriction diminishes airway, edema and secretion

Front 15

What are the classifications of asthma?

Back 15

Acute and Chronic

Front 16

What is the differentiation criteria for chronic asthma?

Back 16

Mild, moderate, and severe persistent disease?

Front 17

What are some of the pathophysiology of asthma?

Back 17

Local release of mediators, overactivity of the PANS

Front 18

How is bronchospasm initiated?

Back 18

By activating the specific and non-specific immune system by degranulation of bronchial mast cells

Front 19

Describe allergic asthma?

Back 19

Antigen binds IgE on surface of mast cells causing degranulation

Front 20

How does degranulation of mast cells trigger asthma?

Back 20

Histaminic release, bradykinin, leukotrienes C, D, E and platelet activating factor; Protaglandins (PG) PGE2, PGF2alpha and PGD2, neutrophil and eosinophil chemotactic factors

Front 21

Describe how the PANS system work with asthma?

Back 21

PANS maintain normal bronchial tone, Vagal afferents in bronchi are sensitive to histamine, noxious stimuli, cold air, inhaled irritants and instrumentation

Front 22

How does vagal activation cause bronchoconstriction at the molecular level?

Back 22

It activates the increase in cGMP or cyclic guanosine monophosphate

Front 23

How does Residual Volume and Functional Residual Capacity change during a severe asthma

Back 23

RV increased 400% and FRC by 100%

Front 24

What is the sign of respiratory failure in a patient with acute asthma attack?

Back 24

High or normal paCO2 may indicate that the patient can no longer keep up with breathing

Front 25

What does Beta 2 activation produce at the molecular level?

Back 25

It activates receptors on smooth muscles that in turn activates adenylate cyclase, which increases cAMP

Front 26

How does methylxanthines work?

Back 26

They produce bronchodilation by inhibiting phosphodiesterase the enzyme that breaks down cAMP

Front 27

What are other effects of methylxanthine?

Back 27

Cathecholamine release, histamine release blockade, and diaphragmatic stimulation

Front 28

What is the therapeutic blood level of theophylline?

Back 28

10-20 ug/ml.

Front 29

What measurement is ideal for patients with asthma during maintenance treatment?

Back 29

Peak Expiratory Flow rate > 200L/min, if less than 50% can be indicative of severe asthma

Front 30

Which induction agent is ideal for emergency surgery or hemodynamically unstable for a patient with asthma?

Back 30

Ketamine has bronchodilating effect

Front 31

How can reflex bronchospasm be blunted?

Back 31

Use thiopenthal (1-2mg/kg), volatile agent at MAC for 5 minutes, IV or intratracheal lidocaine

Front 32

Is succinocholline safe for patients with asthma?

Back 32

It is generally safe, although it is associated with some histaminic release

Front 33

Why is halothane avoided in adults with asthma?

Back 33

Although a potent bronchidilator, halothane can sensitize heart to B2 agonists and can cause hepatotoxic side effects.

Front 34

How is severity of bronchospasm related to end tidal CO2?

Back 34

Severity is inversely related to rise of ETCO2

Front 35

What are some intraoperative findings of bronchospasm

Back 35

Increased peak inflation pressures, plateau pressure is unchanged, decreased exhaled tidal volumes, slow rise of wave form on capnograph

Front 36

How do you treat bronchospasm? How do you prevent it?

Back 36

Increase the volatile agents, treat with lidocaine bolus 1-1.5mg/kg or infusion of 1-2 mg/min

Front 37

What is the diagnosis of COPD?

Back 37

Productive cough on most days on 3 consecutive months for at least 2 consecutive years

Front 38

What are some changes of COPD?

Back 38

Erythrocytosis, pulmonary hypertension, right ventricular failure or cor pulmonale, CO2 retention, decreased ventilatory drive sensitivity to CO2 and more dependent to O2

Front 39

What enzyme is associated with emphysema?

Back 39

Elastase that destroy the alveoli, it is inhibited by alpha 1 antitrypsin

Front 40

What are some dynamic findings in emphysema

Back 40

Increased RV, FRC, TLC and RV/TLC ration

Front 41

What are the complication of emphysema?

Back 41

Increased dead space, although there are normal arterial and oxygen tensions, but only slightly reduced but CO2 is normal

Front 42

What is the danger of administering O2 to patient with COPD / emphysema

Back 42

The loss of hypoxic respiratory drive due to PaO2 greater than 60mm Hg, can cause extreme CO2 retention, hypercarbia and acidosis

Front 43

How do you buff a patient with COPD?

Back 43

Correct hypoxemia, relieve bronchospasms, mobilize and reduce secretions, treat infections

Front 44

How long should smoking be stopped prior to elective operations?

Back 44

6 to 8 weeks to decrease secretions, and reduce pulmonary complications

Front 45

When should humidified air be used?

Back 45

If surgery is greater than 2 hours

Front 46

When should N2O be avoided?

Back 46

Whenever a patient has a bullae and those with pulmonary hypertension. Bullae can explode while pulmonary artery pressures may elevate

Front 47

What are the symptoms of tension pneumothorax as a result of a bullae blowing up?

Back 47

Hypotension, hypoxemia, increased peak airway pressures, decreased tidal volumes, tracheal deviation and absent chest rise and movement in affected side

Front 48

Which patients with COPD might require prolonged postoperative ventilation or ICU stay

Back 48

FEV1 below 50%

Front 49

What are signs and symptoms of intraoperative pulmonary embolism?

Back 49

Unexplained hypotension, hypoxemia, and bronchospams, decreased ETCO2 concentration

Front 50

What is the treatment for PE?

Back 50

If air is identified in the right atrium, emergent central vein cannulation and aspiration of air is life saving