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34 Cards in this Set
- Front
- Back
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Lung cancer is the #1 cancer deaths among males and females.
True or False |
True
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What percentage of lung cancer occurs in cigarette smokers?
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90%
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What are the symptoms of lung cancer?
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chronic cough
coughing blood chest pain wheezing wt loss, appetite loss repeated bronchitis, pneumonia, unexplained fever neck swelling |
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How is lung cancer diagnosed?
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CXR
MRI CT/Pet scan Sputum cytology needle biopsy bone scan |
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What is the number 1 treatment of lung cancer?
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Surgical resection
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What are the 4 M's of Lung cancer anesthesia considerations?
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1. Mass effects Obstructive, nerve damage, etc)
2. Metabolic effects (lambert-eaton, hypercalcemia, hyponatremia, cushing) 3. Metastases (bone, brain, liver adrenal) 4. Medications (chemo) |
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What is the current trends with smoking?
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Increase in cigar smoking
25% of US adults men>women white students HS dropouts |
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What are examples of surgical cases related to lung cancer?
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bronchoscopy
mediastinoscopy thoracoscopy thoracotomy thymectomy |
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What is the avg pt profile for thoracic procedures?
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Male
age 60-70 + smoker Resides in urban area |
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Preop assessment CV findings that predict high risk for thoracic procedure?
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Unstable angina,
MI within 6 weeks significant arrhythmias |
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Preop assessment Pulmonary findings that indicate high risk for lung resection?
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FEV1 <40% of predicted-- and further exercise testing should be done.
FVC<50% DLCO <50% (FEV1 >80% of predicted or >2L ind minimal risk) |
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Pt has a deviated trachea for thoracic surgery-- what are the anesthesia concerns?
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AFOI or Single lumen vent.
SVC compression Phrenic nerve involvement Tumor in airway Neuro-endocrine involvment Large tumor at periphery pulling trachea to same side, or oat cell ca--very aggressive. |
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What is a typical finding on an ECG with pt's presenting for lung resection?
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RVH and RAH: low voltage QRS waves and poor r-wave progression and P-wave changes.
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Findings on a VQ scan that can indicate poor outcomes for lung resection?
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> 70% blood flow to resected lung
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When is the optimal time for a patient to stop smoking preop?
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Stopping smoking within 2months of surgery have an increase in transient mucus production and increase complications.
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What are the benefits of smoking cessation if stopped >8wks?
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improved mucociliary clearance
dec in small airway secretions dec in airway reactivity |
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What are the required monitors for thoracic surgery?
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ECG, (leads II & V5)
Esophageal Stethoscope temp monitor CVP/PA/TEE Arterial line ABG baseline Capnograph Airway pressure monitor Pulse ox |
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which arm is the arterial BP monitor placed for thoracic surgery?
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Usually placed in the dependent arm,-- can detect decreased perfusion to that arm from pressure, and can be stabilized there.
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Which arm is the ABP placed for mediastinoscopy?
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Often placed in the Right arm, - detects compression of the innominate artery and helps prevent a decrease in cerebral blood flow. (if not a pulse ox should be placed on this arm for same reason)
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What are the absolute indications for one-lung ventilation and isolation?
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To prevent contamination from:
Infection hemorrhage Lavage |
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What are the ABSOLUTE indications for one lung ventilation r/t discrete control of ventilation?
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Broncho-pleurel fistula
Giant cysts/bullous disease Major bronchial disruption Life threatening hypoxemia Unilateral lung lavage |
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What are the RELATIVE indications for one-lung ventilation R/T high priority surgical exposure?
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Pneumonectomy
thoracic aortic aneurysm upper lobectomy thoracoscopy (VATS) Mediastinal exposure |
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What are the RELATIVE indications for one-lung ventilation R/T low priority surgical exposure?
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Esophageal surgery
Middle or lower lobe surgery Thoracic spine procedures |
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What are the three types of Double lumen ET?
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Carlens: Left Bronchus intubated
White: Right Bronchus intubated Robertshaw : R or L; no carina hook*****(used mostly) |
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When is a bronchial blocker used?
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When securing the airway is anticipated to be difficult.
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The Fogarty tube is a bronchial blocker that can be placed and positioned using what device?
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Bronchoscope is used to position the balloon into the correct bronchus
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What are the sizes of DLEBT to be used on adults?
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females: 35 -39 fr
Males 37 - 41 fr Typical depth is 27-29cm |
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What is the shape of the trachea and what is used as a landmark during bronchoscopy to indicate a posterior view?
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"D" shaped trachea with the flat muscul0-membrane portion indicating posterior
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The R lung has how many lobes? What is the amount of blood flow to it?
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R lung: 3 lobes and receives 55-60% of blood supply (left lung has 2 lobes and receives 40-45%)
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What is the minimal size of ETT for the use of a 4.9mm Bronch?
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37fr (a 3.6mm can pass through a 35fr tube but can be too flexible for proper use)
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When checking placemnt of a DLT the first step is to listen bilaterally, what does it mean when BS are heard on one side only?
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Both lumens are in the same bronchus-- deflate the cuff and withdraw tube 1-2cm until breath sounds are heard bilaterally.
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What will you hear if the DLT is out too far in the trachea? (cuffs deflated)
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Breath sounds are heard R and L when each side is clamped. ( If cuffs are inflated the left cuff may occlude the right lumen and no BS may be heard with the R.)
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What are the rules for Bronchoscope use?
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1. Left hand on Rigid
2. No bending of scope 3. No advancement w/o visualization 4. maintain a central view 5. Approaching the glottis-- keep tip elevated 6. max air in blue balloon (bronchus) is 1.5ml |
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The Bronch is placed down the Right lumen to verify the placement of the DLT, what should be seen?
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1. a straight-ahead view of the tracheal carina
2. the left lumen going off into the left mainstem bronchus 3. the upper surface of the left EB cuff just below the carina |
