Principles Ii, Exam 1

Front 1

What are the obstructive lung disorders?

Back 1

-asthma
-emphysema
-chronic bronchitis
-cystic fibrosis
-bronciectasis
-bronchiolitis

Front 2

Asthma is characterized by variable _____ _____ airflow obstruction and airway/bronchial ______________.

Back 2

reversible expiratory
hyper-responsivenss

Front 3

Asthma is generally allergen-induced immunologic responses by _____________.

Back 3

several chemical mediators

Front 4

Flow volume loops for obstructive disease are affected on ______. FEV1 is less than of equal to _____% of predicted.

Back 4

expiratory
60

Front 5

The degree of reversilbility, increased airway hyper-reactivity and after admin of bronchodilators you will see a 12% or greater increase in FEV1 and 200 ml increase in Peak expiratory flow rate are the things that make...?

Back 5

asthma different from chronic bronchitis

Front 6

Preop Assessment for Asthma...

Back 6

-what is your breathing baseline and how is your breathing now?
-current clinical symptoms, last exacerbation, infections?
-medication regimen
-comparison and review of PFTs
-exercise tolerance?
-sputum at baseline and what is it currently?
-last time presented to ED and last time received systemic steroids?
-benefit to stop smoking 8 wks preop
-thorough chest auscultation

Front 7

smoking cessation is beneficial to surgical pts greater than ____ weeks preop but not any sooner.

Back 7

8 weeks

Front 8

Preop laboratory studies for asthma?

Back 8

-CXR: for baseline, signs of infections, severity of dx
-FEV1 or PEFR to assess severity of dx
-Full PFTs
-Baseline ABG
-Perhaps EKG to assess right heart failure

Front 9

an additional dose of ____ and _____ ____ may be given just before induction (inhalers and systemic corticosteroids)

Back 9

ipratropium and beta agonist

Front 10

You should avoid giving an ___ ______ before anesthesia for the risk of bronchospasm. Consider using non pariculate antacid such as bictra or reglan.

Back 10

H2 blocker

Front 11

Asthma can be managed preop by Leukotriene inhibitors like ______, beta adrenergic agonists like _____-_____ or anticholinergic drugs like ______-____

Back 11

singulair
salmetrol-serevent
tiotropium-spiriva

Front 12

_____ is classified as a histamine blockers.

Back 12

chromolyn

Front 13

Chromolyn works by suppressing the secretory response of ___ ____ reaction

Back 13

IgE-Antigen

Front 14

Chromolyn is effective only in _____ ___ not basophils.

Back 14

mast cells

Front 15

How is chromolyn deliverd?

Back 15

only by inhalation

Front 16

Chromolyn can only be used ______ and is ineffective following histamine release.

Back 16

prophylactically

Front 17

Examples of inhaled corticosteriods are?

Back 17

Beclomethason (QVAR)
Tramicinolone (Azmacort)
Fluticasone (Flovent)

Front 18

The PO corticosteroid most given is _____. It can cause hypothalmic pituitary adrenal suppression so if the pt has received it in the last ____ months give Solucortef 100mg preop.

Back 18

prenisone
6

Front 19

Corticosteriods have __________ effects on the bronchial mucosa. Stabilize ____ cell membranes. Decrease airway ________. Controls chronic symptoms and prevents ______.

Back 19

-anti-inflammatory
-mast cell
-hyper-responsiveness
-exacerbations

Front 20

Cysteinyl-lekotriene (CysLT1) antagonist is a?

Back 20

leukotriene inhibitor

Front 21

Cysteinyl-lekotriene (CysLT1) competitively blocks ______ __ from binding to the receptor. Examples of this are Zafirlukast, montelukast and pranlukast.

Back 21

leukotriene D4

Front 22

Leukotriene inhibitors also inhibit the conversion of ______ acid to leukotriene A inhibiting the generation of leukotrienes. An example is Zileuton.

Back 22

arachidonic acid

Front 23

____ is a good induction choice for asthmatics because it bronchiodilates but a downfall is that it also increases secretions.

Back 23

ketamine

Front 24

both ____ and ____ are good choices for induction in an asthmatic because they bronchodilate and don't release histamine.

Back 24

etomidate and propofol

Front 25

the ____ form of propofol dose contain sulfites so this should be avoided in an asthmatic.

Back 25

generic

Front 26

the neuromuscular relaxants that release histamine and should be avoided in an asthmatic are?

Back 26

succinylcholine and atricurium-dose and speed dependent
(curare, mivacurium)

Front 27

Regarding pain management in an asthmatic; ____ should be avoided due to histamine release but fentanyl and analogues are okay to use.

Back 27

morphine

Front 28

avoid ____ and ____ in asthmatic related to prosteglandin decrease.

Back 28

ketorolac and NSAIDs

Front 29

All volatile anesthetics are potent _____ but _____ and ____ may irritate the airway.

Back 29

bronchodilators
iso and des

Front 30

reversing neuromuscular blocking agents is not a problem in the asthmatic because _____ are always given with the reversal which is an anticholinesterase.

Back 30

anticholinergic

Front 31

the most critical time intraop is?

Back 31

airway instrumentation

Front 32

Although regional anesthesia may decrease the risk of airway induced bronchospasm, a high spinal may aggravate ______ by blocking sympathetic tone (T1-T4)

Back 32

bronchoconstriction

Front 33

What are the goals of induction in the asthmatic patient?

Back 33

-achieve deep anesthesia before airway manipulation and surgical stimulation
-avoid histamine releasing drugs
-avoid bronchospasm

Front 34

Again, the agents to avoid in an asthmatic are?

Back 34

-morphine
-atracurium
-mivacurium
-meperidine
-succinylcholine (sometimes ok to use)

Front 35

administering ipratropium and a beta 2 agonist just before ____ help to reduce bronchospasms.

Back 35

induction

Front 36

1-1.5mg/kg IV of ______ can also help to reduce bronchospasm.

Back 36

lidocaine

Front 37

Some things to think about for differential diagnosis for wheezing...

Back 37

-foreign body
-partially blocked/kinked ETT
-light anesthesia
-aspiration
-endobronchial intubation
-tension pneumo
-pulm embolism
-pulm edema
-acute exacerbation of asthma
-anaphylaxis

Front 38

What is the first step of management for an OR emergency related to asthma?

Back 38

deepen your anesthetic agent and 100% FiO2

Front 39

What is the second step of management for an OR emergency related to asthma?

Back 39

-auscultate the chest
-verify the problem is bronchospasm
-check patency and position of ETT

Front 40

What is the third step of management for an OR emergency related to asthma?

Back 40

-admin medications
-b-adrenergic agnosits
-iv hydrocortison (1.5-2mg/kg
-epi (0.1mcg/kg bolus)
-aminophylline

Front 41

for emergence of an asthmatic giving 1.5-2mg/kg of ____ may help to blunt airway reflexes

Back 41

lidocaine

Front 42

_______ is the most common pulmonary disorder and it effects more men then women.

Back 42

COPD

Front 43

COPD is the loss of elastic recoil of the lung due to destruction of the lung ____. This leads to the collapse or airways during ____, leading in turn to an increase in airway ____.

Back 43

parenchyma
expiration
resistance

Front 44

the obstruction of airway outflow can lead to the enlargement of _____ distal to terminal bronchioles.

Back 44

air spaces (bullae)

Front 45

Preop treatment for COPD includes

Back 45

-supportive
-smoking cessation
-bronchodilators and glucocorticoids
-ipratropium (more effective than B2 agonists in COPD)
-treat hypoxemia carefully

Front 46

Giving oxygen to patients with COPD presents a problem because it can raise ___ in patients who already have CO2 retention.

Back 46

PaCO2

Front 47

Giving oxygen to patients with COPD presents a problem because elevating ____ can lead to respiratory failure and it can abolish ______.

Back 47

PaO2
hypoxic pulmonary vasoconstriction (HPV)

Front 48

What is the preop managements for COPD

Back 48

-thorough pulmonary eval
-cardiac eval
-cessation of smoking
-abx if warranted
-review of lung expansion procedures (spirometry)

Front 49

what is the intraop management for COPD?

Back 49

-use of minimally invasive surgery
-consider regional anesthesia
-avoid long acting neuromuscular blocking agents
-alines, central lines?
-use of PEEP
-humidified O2
-N2O?

Front 50

_____ ____ follows prolonged exposure to environmental irritants with a hyper-secretion of mucus and inflammatory changes in the bronchi. There is also a productive cough.

Back 50

chronic bronchitis

Front 51

the preop eval for COPD includes?

Back 51

-assessment of current symptoms (dyspnea, cought, sputum)
-hx of respiratory infection and exercise tolerance
-thorough chest auscultation
-consider PFTs, ABG, CXR, EKG

Front 52

Preoperatively if the COPD pt exhibits signs of respiratory infection give them ____ and possibly _____ if there is a reversible component present.

Back 52

antibiotics, bronchodilators

Front 53

Regional anesthesia may offer benefits for surgery of the extremities and lower abdomen because it is ____ or below.

Back 53

T10

Front 54

You must use ____ cautiously because you want to treat post op pain but avoid respiratory depression.

Back 54

opiods

Front 55

The advantages to N2O are that it decreases the dose of ____ ____ and it goes quick on and quick off.

Back 55

volatile anesthetics

Front 56

one disadvantage of N2) is that it can diffuse into ______ quicker than nitrogen can exit, potentially leading to bullae rupture and tension pneumo.

Back 56

airspaces

Front 57

another disadvantage of N2) is that concentrations between ___ and ___ % can limit the concentration of oxygen that can be administered while maintaining the appropriate level of anesthesia.

Back 57

50-70%

Front 58

_____ _____ occurs due to air trapping. Also called dynamic hyperinflation. Because air cannot be exhaled, pressure builds up in the lung leading to _______.

Back 58

-intrinsic PEEP
-positive end expiratory pressure (PEEP)

Front 59

in COPD there is increased ____ ___ due to airway obstruction. Meaning, all inspire4d air does participate in gas exchange and exhaled gas may not contain a normal amount of ____ measured by capnography.

Back 59

dead space
CO2

Front 60

Restrictive lung disease characteristics are?

Back 60

-decreased vital capacity
-expiratory flow rates remain normal
-FEV1 and FVC will be reduced
-FEV1/FVC is preserved at >0.7

Front 61

What are the types of intrinsic restrictive pulmonary diseases?

Back 61

-pulm edema
-ARDS
-Pneumonitis
-idiopathic fibrosis
(may also see an increased AaO2 gradient)

Front 62

What are the types of extrinsic restrictive pulmonary diseases?

Back 62

-pleural effusion
-obesity
-kyphoscolisosis
-ascites
-pregnancy

Front 63

Restrictive pulmonary disease have a decreased lung compliance due to an increase in _________.

Back 63

extravascular lung fluid

Front 64

In Restrictive pulmonary disease there should be no ____ surgery. If emergency surgery is needed, oxygenation and ventilation should be optimized

Back 64

elective

Front 65

In Restrictive pulmonary disease use _____ support as needed.

Back 65

pressor

Front 66

Sarcoidosis causes small lumps which generally heal but if they do not the tissue can remain inflamed and become _____. This can develop into pulmonary fibrosis which distorts the structures of the lungs and can interfere with _____.

Back 66

scarred
breathing

Front 67

Also, _____ can occur from sarcoidosis. This is where pockets form in the air tubes of the lungs and become sites for infections.

Back 67

bronchiectasis

Front 68

On the flow-volume loop for Restrictive pulmonary disease both ____ and ____ are affected.

Back 68

inspiration and expiration

Front 69

People with Restrictive pulmonary disease suffer from increased work of breathing because increased effort is needed to move air in and out of the lungs---less air (_____) is moved per decrease in intrapleural ____.

Back 69

volume
pressure

Front 70

Increased PaCO2 in patients with Restrictive pulmonary disease represents _____ disease. Early on these pts may be hypocarbic however late in the disease the patient will live with a higher PaCO2 in return for not working as hard to breathe.

Back 70

advanced
-hypercarbia and arterial hypoexemia cause vasocontrictive pul htn and cor pulmonale

Front 71

Regional anesthesia on patients with Restrictive pulmonary disease is similar to regional in other lung disease (safe below T10 as to not impair breathing) however, ____ may be difficult.

Back 71

positioning

Front 72

for patients with Restrictive pulmonary disease undergoing GA, _____ and increased ____ may be required.

Back 72

PEEP and Oxygen

Front 73

In pts with Restrictive pulmonary disease you can predict post op problems if FVC is less than ____ ml/kg and a preop PaCO2 higher than ___.

Back 73

15
50

Front 74

Restrictive pulmonary disease pts by definition have decreased _______. And surgery especially of the abdomen or throax decrease these further. This may make it difficult to clear ______.

Back 74

preop lung volumes
secretions

Front 75

It is important that asthma is considered _____ whereas COPD is not.

Back 75

reversible

Front 76

if you are giving a neb through an ETT you are losing half of the dose so ___ the dose.

Back 76

double

Front 77

Wet airways trigger _____ so make sure to have a dry airway.

Back 77

laryngospasm

Front 78

For a COPD patient, dont have insp pressures greater than _____ on pressure mode.

Back 78

30

Front 79

To help patients with COPD you can _____ the I:E ratio.

Back 79

increase
go from 1:2 to 1:3

Front 80

Know the COPD pts _____ baseline and make sure they are at it when waking up=drive to breathe.

Back 80

CO2

Front 81

The ___ position offers optimal access of the lungs, pleura, esophagus, great vessels, vertebrae and other mediastinal structures. It alters normal ____ ____ making the pt at risk for hypoxia. The ____ lung is less compliant.

Back 81

-lateral
-V/Q relationship
-lower

Front 82

____ effectively redirects blood flow away from hypoxic or poorly ventilated lung units by the vascular endothelium releasing potent vasocontrcitor peptides called endothelin.

Back 82

HPV

Front 83

______ >1 MAC and ____ block HPV.

Back 83

Volatile anesthetics and N2O

Front 84

when one side of the chest is opened the negative pressure is ___ and elastic recoil of the lung on that side tends to ______. This can cause progressive hypoxemia and hypercapnia. Effects are overcome by _________.

Back 84

lost
collapse it
positive pressure ventilation

Front 85

Mixing of _____ blood from the collapsed upper lung with oxygenated blood from the ventilated dependent lung widens the alveolar to arterial O2 gradient and often results in ______. Fortunately, blood flow to the non ventilated lung is decreased by ___.

Back 85

hypoxemia
HPV

Front 86

____ to _____ is poorly matched in mechanically vented pts.

Back 86

ventilation to perfusion

Front 87

______ pushes gas into apexes of lung which follows the path of least resistance.

Back 87

positive pressure ventilation

Front 88

blood perfuses primarily the ____ parts of lung due in part to the pull of gravity.

Back 88

dependent

Front 89

The result of PPV in pts in gas flow to the ____ and blood flow to the ____ resulting in ______ ____.

Back 89

apex
bases
VQ mismatch

Front 90

Poorly ventilated alveoli are prone to _____ and ____.

Back 90

atelectasis and collapse

Front 91

What are the indications for one lung ventilation (OLV)

Back 91

-lung resection
-drainage of abscess, cyst or empyema
-bronchopleural fistula
-bronchial tumors
-lung transplant
-persistent intrapulmonary bleeding (PA rupture)
-esophageal surgery
-anterior approach to the thoracic spine
-select open heart procedures
-improve pt outcomes

Front 92

OLV can improve pt outcomes by restricting _____ or ____ to one lung.

Back 92

infection or bleeding

Front 93

OLV can differentially ventilate each lung after trauma, post op or with a ______ fistula.

Back 93

bronchopleural

Front 94

Which mainstem bronchus is longer, the left or right?

Back 94

left

Front 95

the right upper lobe orifice is ____ cm from the carina and is higher than the left upper lobe orifice at ___ cm.

Back 95

2.5cm
5cm

Front 96

the adult trachea is ___-___ cm long

Back 96

11-13

Front 97

The trachea begins at the cricoid which is?

Back 97

C4-C6

Front 98

The trachea bifurcates at the carina which is?

Back 98

T4-T6

Front 99

The right mainstem diverges away at a ___ degree angle. The left mainstem diverges away at a ___ degree angle.

Back 99

25
45

Front 100

The following methods are used in OLV.

Back 100

-double lumen ETT
-single lumen ETT with a built in bronchial blocker
-single lumen ETT with an isolated bronchial blocker (wire guided)
-endobronchial intubation of a single lumen ETT

Front 101

The disadvantages of single lumen endobronchial tube are?

Back 101

-inability to ventilate or suction other lung
-if placed in right lung, cannot ventilate right upper lobe

Front 102

the bronchial blocker is placed under ____ guidance. They are beneficial to patients already ______/_____.

Back 102

fiberoptic
intubated/trached

Front 103

The appropriate size double lumen tube for females is ___-___ fr. for males it is ___-___fr.

Back 103

35-37 (usually 37)
37-39 (usually 39)

Front 104

in the awake and upright position, you have perfusion to the ____ and lower ventilation from negative pressure generated from spontaneous breaths.

Back 104

bases

Front 105

in the asleep and upright position you have perfusion to the ____ (gravity dependent) and ventilation to the ____ because of PPV=V/Q mismatch

Back 105

bases
upper

Front 106

In the asleep and lateral position, you have perfusion to the dependent side and ventilation to the ___ lobes from PPV. This is a worsened V/Q mismatch because paralysis, bean bags, open chest

Back 106

upper

Front 107

complications of double lumen tubes

Back 107

-HYPOXIA
-traumatic laryngitis
-tracheal-bronchial rupture
-ETT suturing/stapling in the bronchus
-decreased venous return

Front 108

Complications of a throacotomy

Back 108

-volume overload
-broncial disruption
-pneumonia/atelectasis
-pulm htn
-Low CO (r heart failure, decreased preload)
-bleeding
-dysrythmias

Front 109

-Managing OLV, you should avoid ____.
-To protect HPV, use ____ and narcotics (avoid IAs)
-Use muscle relaxants and atropine

Back 109

-N2O
-TIVA

Front 110

During OLV, restrict ____ because lungs are a venous reservoir.

Back 110

fluids

Front 111

During OLV you should have an ____ to monitor for decreased venous return and monitor ABG.

Back 111

Aline

Front 112

When ventilation a OLV make sure you are using ____% FiO2. Maintain a PIP < ____ by adjusting TV (avoiding major adjustments).

Back 112

100%
30

Front 113

If hypoxia develops during OLV you can compensate by?

Back 113

-PEEP to dependent lung
-CPAP to non dependent lung
-insufflation of O2 to non dependent lung

Front 114

Preop eval for common thoracic procedures include?

Back 114

-lab tests
-prescreen for underlying pulm infection
-tracheal stenosis, positional dyspnea, airway collapse, hypoxemia, anatomic narrowing?
-review abg, PFT, CXR, V/Q scan, CT/MRI, angiography
-coexisting patho

Front 115

Transfuse preop lung pt with pre op Hct less than __%

Back 115

25%
-T and C 2-4 units of blood

Front 116

lung cancer patients may have myasthenic syndrome with increased sensitivity to __________.

Back 116

non depolarizing muscle relaxants

Front 117

When is the lateral decub position the aline should be in the ____ arm. When doing a mediastinoscopy the aline should be in the ____ arm.

Back 117

dependent
right

Front 118

The central line should be in the ______side of neck. Pressure reading may be affected by open chest, lateral position and surgical manipulation.

Back 118

non dependent

Front 119

epidural anesthesia reduces volatile agents requirements but epidural anesthesia may create sympathetic blockade and ____.

Back 119

hypotension

Front 120

opening the chest produces _____.

Back 120

pneumothorax

Front 121

manipulation of the lung, heart, and major vessels may interfere with ______________________ intraop and post op.

Back 121

ventilatory exchange and cardiovascular stability

Front 122

the lateral decub position changes the distribution of blood flow and pattern of ventilation and exposes lower lung to danger of contamination by ____, ____ or ____.

Back 122

secretions, blood or fluids

Front 123

Open thorax surgery risks include...

Back 123

-dysrhythmias
-DVT
-PE
-MI
-bronchopleural fistula
-chylothorax
-subq emphysema
-phrenic nerve injury
-recurrent laryngeal nerve injury

Front 124

Small cell (oat tumors) account for ___% and non small cell tumors account for ____%.

Back 124

20%
80%

Front 125

-Often proceeded by bronchoscopy/mediastinoscopy
-lateral or posterior lateral thoracotomy incision
-lateral decub position
-double lumen tube
-time=2-3 hours
-EBL= <500ml
-post op care = ICU
-careful attention to chest tubes
-mortality= +/- 1%
-pain score= 7-8

Back 125

lung resection

Front 126

intrapulmonary hemorrhage is characterized by massive hemoptysis r/t trauma, pulm artery rupture, erosion into vessel by trach, abcess or tumor. This requires immediate _____ with ____% FiO2, suctioning the airway, lung iso if unilateral involvement. May need thoracotomy and surgical repair

Back 126

intubation, 100%

Front 127

_____ ____ and ____ can be air filled, thin walled, bronchogenic or alveolar destructive, post infective, infantile or emphysematous cysts.

Back 127

lung cysts & bullae

Front 128

_____ may rupture cysts or bullae = tension pneumo

Back 128

positive pressure

Front 129

Once cysts or bullae are removed, _____ is usually improved.

Back 129

respiration

Front 130

key points to remember with cysts and bullae are...?

Back 130

-PPV < 10cm (may need double lumen tube)
-No N2O
-Extubation-smooth and without coughing

Front 131

____________ is an autoimmune disorder with prejunctional decreased Ach release and no improvements with anticholinesterases. The peripheral muscles and pelvis are most affected.

Back 131

myasthenic syndrome-eaton lambert syndrome

Front 132

The underlying malignancy of myasthenic syndrome is?

Back 132

small cell cancer of the lung

Front 133

Symptoms improve with ____ in myasthenic syndrome

Back 133

exertion

Front 134

muscle relaxants greatly affect myasthenic syndrome patients. ____ having the most effect.

Back 134

NDMR

Front 135

what is a broncho-pleural fistula?

Back 135

abnormal communication between bronchial tree and pleural cavity with pus.

Front 136

what causes a broncho-pleural fistula?

Back 136

pulmonary resection, bronchus or bulla rupture, penetrating chest wound, lung cyst or empyema cavity.

Front 137

the risks of bronco-pleural fistula are ____ may contaminate healthy lung or cause a tension pneumo.

Back 137

PPV

Front 138

The goal with a broncho-pleural fistula is to isolate the _____ lung with a double lumen tube (DLT). Also minimal gas leak through the fistula

Back 138

affected
-lumen is to the unaffected side

Front 139

____ is indicated for stenosis, tumor or congenital defect.

Back 139

tracheal resection

Front 140

With a tracheal resection patient, you may note ____ and the flow volume loop may help you determine where the obstruction is.

Back 140

wheezing

Front 141

with tracheal surgery give minimal _____ to avoid airway obstruction.

Back 141

premedication

Front 142

for induction of tracheal surgery consider ______ induction or awake fiberoptic induction to avoid complete obstruction with loss of muscle tone. Questionable muscle relaxants.

Back 142

inhalation

Front 143

When emerging a tracheal resection, consider ____ the neck to reduce tension and reduce the risk of re-anastomosis

Back 143

flexion

Front 144

What are the three thoracoscopic procedures?

Back 144

-bronchoscopy
-mediastinoscopy
-bronchoalveolar lavage

Front 145

The complications of mediastinoscopy procedures include?

Back 145

-#1 rupture/laceration of the major vessels
-#2 pneumo (hemo) thorax
-intermittent occlusion of the innominate artery (CVA risk)
-tracheal collapse, tension pneumomediastinum, mediastinitis, chylothorax
-phrenic nerve/RLN injury

Front 146

anesthetic consideration with endoscopy are?

Back 146

-small ETT vs. DLT
-laser tube and laser precautions
-short acting hypnotic agent
-inhaled agents vs TIVA
-short acting narcotics
-short acting muscle relaxants
-local anesthesia post op

Front 147

With rigid bronchoscopy you should use _______. The risks/features of rigid include; hypercapnea, hypoxemia, air leaks, anesthesia machine vs HFJV, side arm ventilation port

Back 147

general anesthesia

Front 148

complications of endoscopy include?

Back 148

-facial, dental and laryngeal injury
-airway rupture-pneumo
-hemorrhage
-airway obstruction-blood, edema

Front 149

_______ for thymectomy, medisinal masses, bilateral pulmonary resection.

Back 149

median sternotomy/sternotomy

Front 150

the _____ is the treatment of choice for myastinia gravis patients. it can be done through sternal incision or cervical approach.

Back 150

thymectomy

Front 151

_________ is an autoimmune diease with ocular, pharyngeal, and skeletal muscle weakness. It improves with edrophonium 10mg, corticosteroids, immunosuppresants, plasmapheresis and thymectomy.

Back 151

myasthenia gravis

Front 152

for myasthenia gravis patients they should hold their anticholinesterase med on _______.

Back 152

the day of surgery

Front 153

with myasthenia gravis patients neuromuscular monitoring is indicated but results can be ______.

Back 153

misleading

Front 154

myasthenia gravis pts may need to be vented post op if?

Back 154

-duration of disease greater than 6 years
-coexisting COPD
-anticholinesterase dose greater than 750mg/day

Front 155

resection of neoplasms, anti-reflux procedures and repair of traumatic or congenital lesions are all indications for?

Back 155

esophageal surgery

Front 156

with esophageal surgery you must consider...?

Back 156

-chronic malnutrition related to cancer/swallowing difficulty
-hypovolemia related to swallowing
-aspiration risk

Front 157

during esophageal surgery use an aline, CVP and _____. DLT may be indicated and epidural analgesia can be used ____ and _____.

Back 157

foley
intraop and post op

Front 158

postoperatively pts with esophageal surgery may need to stay intubated for _________.

Back 158

aspiration precations

Front 159

When using the DLT, DL with a ____ MAC blade and advance the tube to at least the ___ cm mark.

Back 159

3
26cm

Front 160

what is the most common error associated with DLT insertion?

Back 160

advancing the tube too far in the bronchus and causing only distal lumen ventilation to one lung

Front 161

the amount of ____ is the main component of oxygenation. HPV may limit ___ unless it is blunted.

Back 161

shunt
shunting

Front 162

The greatest risk of OLV is _________. With that in mind:
TV= 8-10 ml/kg
Adjust RR to keep PaCO2= 40
No PEEP (or less than 5)
Continuous monitoring of O2 and ventilation (SpO2, ABG, ETCO2)
if pulse ox is less than 94% recheck DLT or BB

Back 162

hypoxemia

Front 163

What is the O2 management of OLV

Back 163

-minimize ventilated lung atelectasis
-D/C or avoid N2O to maintain PaO2
-check tube position and suction prn
-PEEP to vented lung (may shunt blood to non ventilated lung)
-CPAP to nonventilated lung (5-8cmH2O)
-Reinflate nonventilated lung with 100% fio2 or have surgeon clamp the PA (last resort)

Front 164

Intraop blood and fluid requirements of OLV

Back 164

-IV 2 large bore
-central line
-aline
-restrict IV fluids (1000-1500 ml NS/LR max)
-1 unit autologous blood if available
-vasopressor if hypotensive
-ephedrine 5-10mg
-phenylephrine 50-100mcg

Front 165

after positioning the patient?

Back 165

reassess breath sounds, vital signs, monitors, lines and IVs

Front 166

when the surgeon is finished lung re-exapnsion is done by _____ ventilation, stacking breaths with increasing pressure.

Back 166

hand

Front 167

filling the chest with water to determine if there is a leak in the lung is known as the?

Back 167

lung bubble test

Front 168

decrease ____ during closing to avoid injury while suturing.

Back 168

TV

Front 169

inflating the lungs to 30 cm H2O not only checks for leaks but it also reinflates areas of ____.

Back 169

atelectasis

Front 170

the surgeon will insert ______ and drain the pleural cavity and aid in lung re-expansion.

Back 170

chest tubes

Front 171

The patient is usually extubated in the OR but if they are remaining intubated, exchange....?

Back 171

the double lumen tube for a single lumen ETT

Front 172

chest tubes can be set to water seal or ____cmH2O. Except in pneumonectomy=water seal only.

Back 172

20

Front 173

the patient will be transferred to the _____ on monitors and nonrebreathing mask.

Back 173

ICU

Front 174

Things to remember...

Back 174

-watch your field
-interact with your surgeon

Front 175

A right DLT is rare but it has an extra murpheys eye to ventilate the?

Back 175

right upper lobe

Front 176

the gold standard for DLT placement is?

Back 176

fiberoptic confirmation

Front 177

When scoping down a DLT you use a ____ scope.

Back 177

peds

Front 178

with thoracic surgery it is better to give ____ for fluid replacement/drop in BP

Back 178

colloids

Front 179

when inserting an ETT for bronchoscopy, you should have the _____ tube possible.

Back 179

largest

Front 180

the blue cuff on the DLT sits in the _____ and the white cuff sits in the _____. the stylet goes through the _____ lumen because it is longer.

Back 180

bronchus
trachea
bronchial/blue