Otterbein/Grant CRNA Basics II Lung Stuff

Upper abdominal surgery can lead to a significant decrease in functional residual capacity (FRC) and arterial oxygen partial pressure (PaO2). This is because the surgery involves the manipulation of the diaphragm and the compression of the lungs, leading to reduced lung expansion and ventilation. Additionally, upper abdominal surgery can result in post-operative pulmonary complications such as atelectasis, pneumonia, and respiratory failure. Therefore, upper abdominal surgery has the greatest decrease in FRC and PaO2 as well as the highest post-op pulmonary complications compared to the other surgery types listed.

Clinically the most detectable changes are reductions in tidal volume and vital capacity

At risk of decreased coughing ability, decreased ERV, increased anxiety

Arterial hypoxemia

Ketamine is a bronchodilator BUT increases airway secretions.

Tracheal stenosis is a condition where the trachea becomes narrow, leading to difficulty in breathing. It can develop as a result of prolonged endotracheal tube (ETT) intubation, which is a common procedure used to assist with breathing during surgery or in critically ill patients. When the lumen of the trachea, which is the inner space, becomes less than 5 mm, it can cause symptoms such as shortness of breath, wheezing, and coughing. Therefore, a lumen size of less than 5 mm is considered significant and indicative of symptomatic tracheal stenosis.

Emphysema causes more structural lung damage compared to chronic bronchitis. Emphysema is a type of chronic obstructive pulmonary disease (COPD) characterized by the destruction of the alveoli in the lungs. This leads to the loss of elasticity and collapse of the air sacs, resulting in reduced lung function and difficulty in breathing. On the other hand, chronic bronchitis is characterized by inflammation and narrowing of the airways, leading to excessive mucus production and coughing. While both conditions are part of COPD, emphysema specifically causes more severe structural damage to the lungs.

Elective surgery should be delayed for 6 weeks in order for airway reactivity to recover in a pediatric patient with a symptomatic acute upper respiratory tract infection. This is because upper respiratory tract infections can cause inflammation and swelling in the airways, which can lead to increased airway reactivity and potential complications during surgery. Allowing a sufficient recovery time of 6 weeks ensures that the airways have returned to their normal state, reducing the risk of complications during the procedure.

Pulmonary fibrosis is a condition characterized by the scarring and thickening of the lung tissues, leading to reduced lung function. This condition is often chronic and progressive, causing symptoms such as shortness of breath, coughing, and fatigue. Chronic intrinsic pulmonary disease refers to lung diseases that originate within the lungs themselves, such as idiopathic pulmonary fibrosis or sarcoidosis. Therefore, chronic intrinsic pulmonary disease is the correct answer as it aligns with the characteristic of pulmonary fibrosis.

Atelectasis is the collapse or closure of a part of the lung, leading to impaired gas exchange. During anesthesia, atelectasis is a common complication due to reduced lung volumes and decreased respiratory effort. It occurs when the alveoli in the lungs collapse, preventing proper oxygenation and carbon dioxide removal. Atelectasis is responsible for the vast majority of impaired gas exchange under anesthesia because it reduces lung compliance and functional residual capacity, leading to hypoxemia and increased risk of postoperative complications. Pleural effusion, bronchospasm, and ARDS can also cause impaired gas exchange, but they are less common than atelectasis in the context of anesthesia.

Chronic bronchitis is a long-term inflammation of the bronchial tubes, which carry air to the lungs. This condition can cause the walls of the bronchial tubes to thicken, leading to a decreased airflow. As a result, the body compensates by producing more red blood cells, a condition known as polycythemia. This increased production of red blood cells helps to improve oxygen delivery to the body's tissues. Therefore, chronic bronchitis can indeed result in polycythemia, making the statement true.

4-8 weeks

12-18 hours for carboxyhemoglobin levels to decrease

Only if indicated: fever or increased WBC >48 hours.

The pathology is not reversible - the damage is chronic/permanent.

Fentanyl is a synthetic opioid that is commonly used for pain management. Unlike morphine, which can cause bronchoconstriction and worsen asthma symptoms, fentanyl does not have this effect. Labetolol is a beta-blocker that can potentially trigger bronchospasm in patients with asthma, and atracurium is a neuromuscular blocking agent that can cause histamine release and bronchoconstriction. Therefore, fentanyl is the only drug in the list that does not pose a significant risk to patients with asthma.

Beta blockers cause bronchoconstriction by blocking the beta-2 receptors in the smooth muscles of the bronchi. This leads to the constriction of the airways, making it harder for air to flow in and out of the lungs. This effect is particularly significant in patients with asthma or chronic obstructive pulmonary disease (COPD), as it can worsen their respiratory symptoms and potentially trigger an asthma attack. It is important for healthcare providers to consider this potential side effect when prescribing beta blockers to patients with respiratory conditions.

Chronic bronchitis is the best condition described as decreased airway lumen diameter due to mucus and inflammation. Chronic bronchitis is a type of chronic obstructive pulmonary disease (COPD) characterized by persistent inflammation and excessive mucus production in the bronchial tubes, leading to narrowing of the airways. This narrowing results in decreased airway lumen diameter, making it difficult for air to flow in and out of the lungs.

During an asthma exacerbation, there is increased airway resistance and bronchoconstriction, leading to decreased airflow and impaired gas exchange. This results in hyperventilation and increased respiratory rate in an attempt to compensate for the decreased oxygen levels and increased carbon dioxide levels. The increased respiratory rate causes a decrease in carbon dioxide levels, leading to respiratory alkalosis. Therefore, the most common ABG finding during an asthma exacerbation is respiratory alkalosis.

Emphysema is a lung disease characterized by the abnormal and permanent enlargement of the alveoli, which are the tiny air sacs in the lungs responsible for oxygen exchange. This enlargement leads to irreversible damage to the alveolar tissue without obvious fibrosis (scarring). The damaged alveoli lose their elasticity, making it difficult for the lungs to properly exhale air. This results in shortness of breath, coughing, and wheezing. Chronic bronchitis, on the other hand, is characterized by inflammation and excessive mucus production in the bronchial tubes, while asthma is a chronic inflammatory condition that causes the airways to narrow and become swollen. ARDS (Acute Respiratory Distress Syndrome) is a severe lung condition characterized by fluid accumulation in the lungs, leading to difficulty in breathing.

Aspiration is most likely to occur during the induction/intubation phase and within 5 minutes of extubation. During induction/intubation, the patient is being intubated and may have a compromised airway, increasing the risk of aspiration. Similarly, during emergence within 5 minutes of extubation, the patient is regaining consciousness and may not have full control over their airway, making them susceptible to aspiration. The maintenance phase of anesthesia and pre-operatively are not mentioned as high-risk periods for aspiration.

FiO2 should be limited to prevent resorption atelectasis and pulmonary toxicity.

Patients with cystic fibrosis often experience excessive mucus production and obstruction in their airways. Anticholinergic drugs, which work by blocking the action of acetylcholine, can cause drying of the airways and thickening of mucus, exacerbating respiratory symptoms. Therefore, it is best to avoid anticholinergic drugs while caring for a patient with cystic fibrosis. B2 agonists, on the other hand, help relax the airway muscles and can be beneficial for these patients. Vitamin K and IV fluids are not specifically contraindicated in cystic fibrosis and may be required for other reasons.

If the partial pressure of arterial oxygen (PaO2) is less than 55 mmHg, it indicates low oxygen levels in the blood. This can be a sign of respiratory distress or lung disease. When the hematocrit (percentage of red blood cells in the blood) is more than 55%, it can lead to increased blood viscosity and reduced oxygen-carrying capacity. Evidence of cor pulmonale, which is right-sided heart failure caused by lung disease, also suggests a need for home oxygen therapy. Therefore, if any of these conditions are present, it is recommended to use home oxygen therapy.

FEV1 stands for forced expiratory volume in one second, which measures the amount of air a person can forcefully exhale in one second. COPD is a chronic lung disease that causes airflow obstruction. FEV1 is a better predictor of COPD severity because it directly measures the lung function and the extent of airflow limitation. On the other hand, the FEV1/FVC ratio measures the percentage of the forced vital capacity (FVC) that can be exhaled in one second. While the ratio is important in diagnosing COPD, it may not accurately reflect the severity of the disease. Therefore, it is true that FEV1 is more predictive of COPD severity than the FEV1/FVC ratio.

Respiratory distress is due to microvascular injury, not fluid overload.

Reduce TV to 4-6 mL/kg, increase RR to 14-18

Or when vent required keep Pao2 between 60 and 100mmHg and the PaCO2 in range that maintains the arterial pH at 7.35 to 7.45

During an asthma attack, the airways become inflamed and constricted, leading to difficulty in breathing. This can result in increased airway pressure, known as Peak Inspiratory Pressure (PIP), as the patient struggles to inhale. Additionally, the constriction of the airways can cause a blunted etCO2 waveform, indicating reduced exhalation of carbon dioxide. Lastly, asthma attacks can also cause hypoxemia, which is a decrease in the oxygen levels in the blood. Therefore, high PIP, blunted etCO2 waveform, and hypoxemia are all indicators of an asthma attack during the intraoperative period.

Patients with restrictive lung disease are at a higher risk of pulmonary complications if their vital capacity is decreased to 15 mL/kg or if their PaCO2 (partial pressure of carbon dioxide in arterial blood) is elevated. This is because a decreased vital capacity indicates reduced lung function and impaired ability to take in and expel air. Elevated PaCO2 levels suggest inadequate ventilation and impaired gas exchange, leading to an increased risk of complications such as respiratory failure or respiratory acidosis. Therefore, a decrease in vital capacity or an elevation in PaCO2 can significantly impact the respiratory status and overall health of patients with restrictive lung disease.

Ranitidine, cimetidine, and famotidine are all H2 receptor antagonists commonly used to reduce stomach acid production. However, in rare cases, these medications can cause unopposed histamine release, leading to bronchospasm. This occurs because H2 receptors normally inhibit histamine release, so blocking these receptors can result in excessive histamine release and subsequent bronchospasm. Diphenhydramine, on the other hand, is a first-generation antihistamine that works by blocking histamine receptors, not H2 receptors, and therefore does not cause unopposed histamine release or bronchospasm.

Ketamine, Desflurane, and Acidosis should be avoided when treating a patient with pulmonary hypertension. Ketamine is a general anesthetic that can cause pulmonary vasoconstriction, worsening the condition. Desflurane is an inhalation anesthetic that can also cause vasoconstriction and increase pulmonary artery pressure. Acidosis, a condition characterized by increased acidity in the blood, can lead to pulmonary vasoconstriction and further exacerbate pulmonary hypertension. Therefore, these three options should be avoided in the treatment of patients with pulmonary hypertension.