Thoracic anesthesia pt2

Question 1

What lung zone exhibits pulsatile blood flow?
What lung zone exhibits non-pulsatile continuous blood flow?
What is the reasoning for the difference?

Answer 1

• Pulsatile = Zone 2
• Continuous = Zone 3
• Gravity: ↑ pressure = ↑ perfusion

Question 2

What lung zone is depicted by 1 in the figure below?

Answer 2

Zone 4

Question 3

Which lung zone is defined by the following:

1. Alveoli maximally distended
2. Complete compression of capillaries
3. Ventilation but no blood flow (dead space)

Answer 3

Zone 1 ( P_A > P_a > P_v )

Question 4

Which lung zone is defined by the following:

1. Restricted venous flow
2. Arterial flow exceeds P_A
3. Flow varies with cardiac cycle

Answer 4

Zone 2

( P_a > P_A > P_v )

Question 5

Where is lung zone 2 located in relation to the heart?

Answer 5

3cm above the heart

Question 6

Which lung zone is defined by the following:

1. Unrestricted blood flow
2. More compliant alveoli & greater ventilation.
3. Vasculature more distended

Answer 6

Zone 3
( P_a > P_v > P_A )

Question 7

In which lung zone will blood flow vary with the cardiac cycle and respirations?

Answer 7

Lung Zone 2

Question 8

Which lung zone’s blood flow is unaffected by the cardiac cycle and respirations?

Answer 8

Zone 3

Question 9

Zone 1 is _____ in healthy patients.

Answer 9

absent

Question 10

In a normal healthy lung P_a will be ______ than P_A.

Answer 10

greater → P_a > P_A

Question 11

What two common things will produce zone 1 ventilation?

Answer 11

• Positive Pressure Ventilation = ↑ alveolar pressure.
• Hemorrhage/shock/hypovolemia = drop in arterial pressure.

Question 12

Why does blood flow in pulses in Zone 2 of the lungs?

Answer 12

Systole = P_a > P_A
Diastole = P_A > P_a

Question 13

For accurate measurement of PCWP, the PA catheter must be placed in which pulmonary zone?

Answer 13

Zone 3

Question 14

Which zone has the greatest perfusion and highest hydrostatic pressures?

Answer 14

Zone 3

Question 15

Which pulmonary function test is used to determine if lung disease is obstructive, restrictive, or normal?

Answer 15

FEV₁/FVC Ratio

Question 16

What is a normal FEV₁/FVC ratio in healthy adults?

Answer 16

70 - 85%

Question 17

What are the most common disease processes exhibiting obstructive patterns?

Answer 17

• COPD (Bronchitis & Emphysema)
• Asthma
• Cystic Fibrosis

Question 18

What is the most common comorbidity in the thoracic surgical population?

Answer 18

COPD

and 3rd leading cause of death in the US

Question 19

What condition is characterized by the following:

• Decreased area for gas exchange
• Air-trapping
• Hyperinflation of lung tissue

Answer 19

COPD

hypercapnia, dyspnea, hypoxia, O2 commonly required (home O2)

Question 20

What environmental factors other than smoking have been implicated in lung cancer?

Answer 20

• Asbestos
• Radon
• Diesel gas
• metals

lung cancer is leading cause of cancer dead ~25%

Question 21

Do the below factors describe SCLC or Non-SCLC?

• Less aggressive
• Affects smokers & non-smokers
• More common
• Better prognosis

Answer 21

Non-Small Cell Lung Cancer

Question 22

Do the below factors describe SCLC or Non-SCLC?

• Fast-growing
• Aggressive
• Associated with smoking
• Usually starts in bronchi
• Metastasizes

Answer 22

Small Cell Lung Cancer

Question 23

What lung cancer is most sensitive (susceptible) to radiation therapy?

Answer 23

SCLC

Question 24

What are the sub-categories of Lung resection? (partial lobe removal)

Answer 24

• Sleeve
• Wedge
• Segment

.

Question 25

What is pleurodesis?

Answer 25

Obliteration of pleural space to prevent recurrence of fluid, pus, or blood build up.

Question 26

What is the most common thoracotomy approach?

Answer 26

Anterolateral *can also do sternotomy or posterolateral approach*

Question 27

Obstructive disease would have a ____ total lung capacity while restrictive disease would have a ____ TLC

Answer 27

Obstructive: normal or increased TLC Restrictive: decreased TLC

Question 28

Interstitial lung disease, pulmonary fibrosis, sarcoidosis are all examples of ____ lung disease

Answer 28

Restrictive lung disease

Question 29

What is the difference between a pneumonectomy and a lobectomy?

Answer 29

Pneumonectomy: entire lung removed Lobectomy: just one lobe removed

Question 30

What is a VATS procedure and how is it performed?

Answer 30

Thoracic surgery done in 1-3 ports, similar to a laparoscopic procedure. May be done robotically *offers reduced hospital stay, less blood loss, less pain, and better postop pulmonary function.*