AP II Exam 3- Thoracic Anesthesia Exam Questions and Answers

AP II Exam 3- Thoracic Anesthesia Exam Questions and Answers True or false: Pleural pressure increases 0.25 cm H20 every centimeter down the lung. The increase in pleural pressure causes a fourfold decrease in alveolar volume - Answer-True West lung zone 1 - Answer-PA>Pa>Pv West lung zone 2 - Answer-Pa>PA>Pv West lung zone 3 - Answer-Pa>Pv>PA West lung zone 4 - Answer-Pa>Pisf>Pv>Pa V/Q V= Q= - Answer-V= 4L/min Q= 5L/min V/Q = ____ for entire lung - Answer-0.8 When Q=0 - there is ventilation without perfusion= - Answer-deadspace When V=0 - there is perfusion without ventilation = - Answer-shunt In the awake patient, the ______ lung receives more perfusion and ventilation (gravity and contraction of hemidiaphragm and more favorable compliance) - Answer-dependent In the anesthetized patient in the lateral position, the ______ lung becomes more compliant and receives greater ventilation. - Answer-upper V/Q mismatch can be improved with? - Answer-PEEP best ventilation on an anesthetized patient → - Answer-upper lung best perfusion on an anesthetized patient → - Answer-lower lung True or false: Lung isolation improves ventilation and perfusion during thoracic surgery→ stops cascade of worsening V/Q mismatch - Answer-true absolute indications for one lung ventilation w/ DLT - Answer-Infection and hemorrhage During OLV, _________promotes blood flow to the dependent lung. -helps to maintain PaO2 in response to low FiO2 -occurs when 20-80% of lung area being hypoxic - Answer-HPV MAC levels for one-lung ventilation - Answer-< 1 High CO and hypervolemia can override ____ - Answer-HPV An increase in ____ pressures inhibit HPV - mitral stenosis, emboli, hypothermia, vasoconstrictors - Answer-PA Direct inhibitors of HPV - Answer-nitroglycerin, nipride, hypocarbia, metabolic alkalosis, nitric oxide, beta agonists, CCBs, aminophylline Surgical indications for one-lung ventilation - Answer-Thoracic aneurysm repair, Pneumonectomy, Lung volume reduction. Some cardiac surgery, Lobectomy, Esophageal surgery, Thymectomy What size ETT for < 165 cm - Answer-35 fr female, 37 fr male What size ETT for 165-179 cm - Answer-37 fr female, 39 fr male What size ETT for > 179 cm - Answer-39 fr female, 41 fr male Left upper bronchus is how many cm from carina? - Answer-5 Bronchial with murphy eye at bronchial cuff to accommodate right upper lobe bronchus (2.5 cm from carina) Malposition and occlusion of right upper bronchus more likely May be needed for descending aortic aneurysm repair - left DLT may rupture aneurysm - Answer-Right DLT Depth for DLT - Answer-usually 27 cm in females and 29 cm in males Steps to verify placement of DLT - Answer-1. inflate tracheal cuff (5-10 ml) — verify bilateral breath sounds 2. Inflate bronchial cuff (2-3 ml) Deflate bronchial cuff as soon as you can 3. Clamp Y-piece of bronchial lumen and vent to air 4. Verify breath sounds to tracheal side and absence to bronchial side 5. Unclamp bronchial limb and clamp Y-piece at tracheal limb 6. Verify breath sounds to bronchial side & absence to tracheal side After placement of DLT with both cuffs inflated you clamp the bronchial limb and open to air. You hear bilateral breath sounds. What is the problem? - Answer-Not deep enough #1 reason you have intra op issues Bronchial limb is still in the trachea → deflate balloon and advance the tube → re-inflate balloon After placement of a left DLT with both cuffs inflated you clamp the bronchial limb and open to air. You hear right sided breath sounds. What is the problem? - Answer-Correct placement of DLT. You have isolated left lung. After placement of a left DLT with both cuffs inflated you clamp the bronchial limb and open to air. You hear left sided breath sounds. What is the problem? - Answer-On the wrong side