Show:
Pathophysiology
Closing Capacity & Airway Irritability
Preoperative Management
Intraoperative Management
Postoperative Management
100
What is the pH of a patient with someone with COPD?
Normal or slightly lower because of compensation; later on in the disease, may decrease
100
Lung volume at which small airways in dependent part of the lungs start to close
What is closing capacity?
100
This will increase a patient's oxygen reserves significantly and should be done before every planned pre-op intubation
What is preoxygenation?
100
What I:E ratio should be maintained during mechanical ventilation of COPD patients?
1:3.5 seconds
100
If the patient has an RSBI of 110, can they be extubated?
No, RSBI must be < 100 to extubate
200
Is the FEV1/FVC ratio low or high for COPD patients?
Low
200
The phase on the single breath nitrogen washout that indicates the start of airway collapse
What is Phase IV of the single breath nitrogen washout?
200
This quick acting beta agonist bronchodilator is a popular choice to reduce bronchospasm and airway irritability preoperatively
What is albuterol?
200
What is a normal plateau pressure?
less than or equal to 30 cm H20
200
Can COPD patients be extubated while under deep anesthesia?
No, you want them awake, alert for extubation
300
What would the V/Q ratio be for COPD patients?
Scattered
300
What happens to closing capacity and closing volume as we age?
Closing capacity and closing volume increase with age
300
You will want to make sure to check an INR preoperatively and will be looking for it to be less than 1.5 if your patient is on this potent blood thinner
What is Coumadin?
300
What is the most common cause of bronchospasm?
Light plan of anesthesia
300
What are at least 3 measures to maintain adequate post-op lung volumes and FRC?
1.) Deep breathing exercises; 2.) Incentive spirometry; 3.) Diaphragmatic breathing (abdominal breathing or belly breathing); 4.) Positive pressure breathing techniques; 5.) Continuous positive airway pressure (CPAP); 6.) Non-invasive positive pressure ventilation (NIPPV); 7.) Chest physiotherapy
400
What causes the destruction of alveoli walls?
Elastase which decreases elastin and collagen
400
What mechanism makes patients with COPD at increased risk for bronchospasm?
Activation of neutrophils, macrophages, and other inflammatory mediators cause airway inflammation, which makes the airways hyperreactive and easily irritated.
400
Using a Mallampati Scoring system pre-op airway assessment, this would describe the most difficult type of airway to intubate
What is class IV?
400
Lack of what inhaled gas results in absorption atelectasis in patients receiving 100% FiO2?
Nitrogen
400
What are the two devices that uses vibratory positive pressure to help patients expectorate?
1.) Lung Flute; 2.) Acapella Vibratory Positive Expiratory Pressure (PEP)
500
Why do COPD patients have longer expiratory flow?
Increased closing capacity, to prevent airway resistance
500
Name 5 drugs that may stimulate bronchospasm?
Desflurane, β blockers, NSAIDs, cholinesterase inhibitors (neostigmine), and histamine releasing drugs (atracurium, mivacurium, sodium thiopental, morphine) are pharmacological triggers of bronchospasm.
500
A pre-op assessment that reveals a patient or family member history of this critical reaction will greatly influence your anesthetic drug selections
What is malignant hyperthermia?
500
What is the name of the special LMA that includes a larger cuff and gastric drain tube?
Proseal
500
What is the advancement in treating COPD that is similar to cardiac stenting?
Lung Volume Reduction (LVR) Coils