Co-Existing Disease Review

During anesthesia for a 5-year-old with a mild URI, which of the following strategies would BEST reduce the risk of perioperative respiratory adverse events?

• Use an ETT instead of LMA and perform rapid extubation

• Administer minimal fluids and use high inspiratory pressures

• Limit airway manipulations, consider LMA over ETT, maintain hydration

• Proceed with standard induction without airway precautions

Which pathophysiological mechanism is most prominent during an acute asthma attack?

• Airway hyperresponsiveness with smooth muscle constriction

• Destruction of alveolar walls

• Fibrotic remodeling of the alveoli

• Loss of surfactant production

Which of the following best explains the mechanism behind post-obstructive (negative pressure) pulmonary edema?

• Alveolar damage caused by aspiration of gastric contents

• Increased alveolo-capillary permeability from histamine release

• High negative intrathoracic pressure increasing venous return and hydrostatic gradient

• Fluid overload from excessive IV fluids during airway obstruction

Why does residual volume increase in COPD?

• Airway narrowing during inspiration traps more air

• Early airway collapse during exhalation prevents full emptying of the lungs

• Patient breathes more rapidly

• Diaphragmatic strength is increased, trapping air

A 68-year-old man with severe COPD undergoes GA for a laparoscopic cholecystectomy. Mechanical ventilation is set with a tidal volume of 8 mL/kg and a rate of 16/min. After 20 minutes, the patient develops hypotension, rising peak airway pressures, and a prolonged expiratory phase with a noticeable plateau on capnograph. Which of the following is the most appropriate immediate intervention?

• Increase tidal volume to 12 mL/kg to improve ventilation

• Administer N2O to reduce airway resistance

• Disconnect ventilator to allow trapped gas to escape

• Increase PEEP to recruit alveoli

A 28-year-old woman with moderate persistent asthma is scheduled for elective laparoscopic cholecystectomy. She uses an albuterol inhaler as needed and an inhaled corticosteroid daily. During induction, she develops wheezing and increasing peak airway pressures after endotracheal intubation. Which of the following is the most appropriate next step?

• Administer IV corticosteroids immediately and continue surgery

• Deepen anesthesia and administer a short-acting inhaled bronchodilator

• Extubate and postpone the procedure

• Increase tidal volume to improve ventilation

A patient has the following preop PFTs: FEV1: 60% predicted FVC: 80% predicted FEV1:FVC ratio: 0.55 Which of the following statements is most accurate?

• Both FEV1 and FVC are within normal limits; PFTs are unremarkable

• This pattern suggests obstructive lung disease

• This pattern suggests restrictive lung disease

• This pattern indicates neuromuscular weakness

A 55-year-old patient with severe bronchiectasis is recovering from a thoracotomy.  The patient has copious purulent sputum, a weak cough, and mild hypoxemia (SpO2 91% on 2L oxygen).  Which of the following interventions is most effective in preventing postop pulmonary complications?

• Early extubation and supplemental oxygen only

• High FiO2 therapy without airway clearance

• Incentive spirometry combined with chest physiotherapy and airway suctioning as needed

• Nebulized bronchodilators only

A 62-year-old man with GOLD stage III COPD presents for an elective laparoscopic cholecystectomy. He continues to smoke and has dyspnea on exertion. Preop evaluation reveals FEV1 40% of predicted and PaCO2 of 50. Which ventilation strategy is best to minimize hyperinflation and auto-PEEP?

• Increase respiratory rate with low tidal volume

• Use prolonged expiratory time with low respiratory rate

• Add PEEP to offset auto-PEEP

• Use a large tidal volume to ensure adequate ventilation

A 16-year-old patient with a history of CF presents for an emergent laparoscopic appendectomy. The patient has thick pulmonary secretions and decreased breath sounds bilaterally. The anesthesia plan of care includes GA with ETT. Which of the following medications should the CRNA avoid administering during this case?

• Fentanyl

• Rocuronium

• Glycopyrrolate

• Ondansetron