Surgical Procedures Midterm Review

Which of the following choices may be considered as an absolute indication for OLV?

• Infectious contamination

• Bronchopleural fistula

• Mediastinoscopy

• Emergent esophageal resection

• Aortic valve replacement

What is the maximum amount of air you can place in the bronchial cuff?

• 3 mL

• 1-2 mL

• 5 mL

• 2 mL

• 5-10 mL

A 62-year-old man with moderate COPD is undergoing a right thoracotomy with OLV. The anesthesia team is using a left-sided DLT. During VCV of the dependent lung, the patient’s PIP rises to 42, plateau pressure is 24, and SpO2 is 92% on FiO2 50%. Which of the following is the most appropriate next step?

• Increase tidal volume to improve oxygenation

• Decrease PEEP to zero

• Check for malposition of the DLT or endobronchial blocker

• Increase FiO2 to 100%

A patient with pulmonary hypertension is undergoing thoracic surgery. The anesthesiologist administers a CCB to control systemic hypertension. Soon after, the patient’s oxygenation decreases despite appropriate ventilatory settings. Which of the following mechanisms explains this change?

• The CCB reduces myocardial contractility, decreasing oxygen delivery

• The drug inhibits HPV, increasing shunt fraction

• The drug increases airway resistance, causing alveolar hypoventilation

• The drug causes systemic hypotension, reducing perfusion to ventilated alveoli

A 25-year-old patient with a history of cystic fibrosis presents for video-assisted thoracoscopy surgery to drain a localized abscess in the right lung. The anesthesiologist plans for OLV. Which of the following best explains the primary purpose of OLV in this patient?

• To increase tidal volume to the operative lung

• To reduce the risk of postop bronchospasm

• To allow high-frequency ventilation of both lungs simultaneously

• To prevent contamination of the healthy left lung for infected secretions

In the lateral decubitus position during anesthesia, which of the following best describes the changes in V/Q relationship?

• The non-dependent lung is better ventilated but poorly perfused

• The dependent lung is better perfused but poorly ventilated

• Both lungs receive equal ventilation and perfusion

• The dependent lung is better ventilated and perfused

During OLV for a right thoracotomy, a patient develops significant hypoxemia (SpO2 85%). The ventilated lung is adequately oxygenated, tidal volume is low, PEEP is 5, and the Volatile concentration is 2 MAC. ABG shows mild hypocapnia. Which of the following could be contributing to impaired hypoxic pulmonary vasoconstriction in this scenario?

• Low tidal volume

• Volatile concentration of 2 MAC

• Peep 5

• Adequate oxygenation of ventilated lung

Which preop test is the most reliable predictor of postop pulmonary complications after lobectomy?

• Chest x-ray

• FEV1 or predicted postop FEV1

• Resting PaO2

• Peak flow rate

Why is RSI often performed for esophagectomy patients?

• Poor pulmonary reserve

• Increased ICP risk

• Poor LES tone and aspiration risk

• To facilitate DLT placement

A 65-year-old male with COPD is scheduled for a right upper lobectomy. His spirometry shows FEV1 55% of predicted and his predicted postop DLCO is 28%. He walks one block before becoming dyspneic. Which of the following best describes his surgical risk?

• Low risk, acceptable candidate for lobectomy

• Moderate risk, predicted DLCO is reassuring

• High risk, increased chance of postop respiratory failure

• Contraindication to surgery regardless of comorbidities