Thoracic Anesthesia and the Respiratory System

Respiratory
Laryngoscopic view
Mallampati
Cor Mc Lehane
Aiway Assessment
upper incisor lenght
maxilla-mandible rel'p
inter incisor distance/ mouth opening
normal jaw closure
jaw protrusion/ prognation
uvula visibility/ mallampati
shape of palate
submandibular space compliance
thyromental distance
neck
length
thickness
range of motion
improve view
cricoid pressure
thyroid pressure
decrease LES tone
may obscure view
C/i: vomiting, unstable C-spine
BURP maneuver=improve view/grade
oxy-Hgb dissociation curve
tissue ph
acidosis
alkalosis
favors O2 release
physiologic changes
P50: 27
Left shift
right shift
2,3 DPG
hypothermia
CO poisoning
2,3 DPG
hyperthermia
Acidosis
alkalosis
fetal Hgb: 18-20
sickle cell
maternal Hgb
Altitude
hyperventilation
inc MV(RR+TV)
HPV
pulmonary hypertension
HAPE
HACE
Reflex Pathways
Parasympathetics
@bronchi and Bronchioles
vagus
Ach M3
bronchoconstrictions
Sympathetics
B2 adrenergic
bronchodilation
salbutamol
epinephrine
tx: glycopyrrolate, atropine
ipratropium
Histamine
H1 receptor
H2 receptor
bronchoconstriction
bronchodilation
LUNG COMPLIANCE
dynamic complicance
Static Compliance
reflect resistance to gas flow
peak airway pressure
decrease: ETT obst., Bronchospasm
pressure required to hold lungs at end inspiration
decreased: stiff lungs, pneumonia
change in volume/ change in pressure
plateau pressure
OBESITY
normal lung compliance
PFT
decreased
ERV
FRC
TLC
FEV1, FVC
rapid desat w/ apnea
increased O2 consumption
restrictive ventilation
normal FEV1/FVC
supine: TV< closing capacity
OSA
STOP BANG criteria
>3: high risk
OSA vs. OHS
AGING
emphysema-like
RV, FRC
PaO2
alveolar surface area
response to CO2 build up
resp. to low O2
chest wall compliance
airway reflexes
lung compliance
closing capacity
closing volume
flow volume loop
inspiratory problem
extrathoracic pathology
expiratory problem
intrathoracic pathology
clinical
URTI
airway reactivity
6wks ff. URTI
risk
laryngospasm
bronchospasm
coughing
desturation
predictors of adverse events
airway surgery
hx of asthma
wheezing, rhonchi
passive smoke exposure
purulent/ productive secretions
Respiratory Failure
Acute RF
hypoxemia
hypoventilation
Preoxygenation/ denitrogenation
ETO2 >90%
CPAP/ PS
safe apnea time
FRC
Obese
pregnant
pediatric pt.
shunt physiology
o2 consumption
fever
Difficult Airway
CVCI
SGA: LMA
Invasive/ surgical airway
Airway edema
ACE inhibitor induced
angioedema
hyperbaric oxygen
indications
toxicity
air embolism
CO poisoning
Cyanide toxicity
CRAO
seizure
o2 toxicity
tracheobronchial irritation
ARDS
100% O2 x 10-12hrs
tx: decrease iO2
sx:
seizures, n/v, twitching
myopia
narrowing visual fields
LAPAROSCOPY
Pneumoperitoneum
Trendelenburg position
PaCO2-EtCo2 gradient
respiratory acidosis
migration of ETT
pulmonary HPN
compliance
Lung volumes and FRC
diaphragm compression
hypercapnea
peak airway pressure
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