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Thoracic Anesthesia

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Basic Clinical Anesthesia

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Abstract

Thoracic anesthesia encompasses the care of patients undergoing thoracic surgery, as well as patients with diseases of the respiratory system undergoing non-thoracic surgical procedures. This chapter is written with the goal of helping the clinician deliver superb anesthetic care to both of these patient groups. To facilitate understanding this topic, selected concepts of basic respiratory physiology, as well as disease states encountered in patients with lung disease, will be discussed. Finally, the intraoperative management of patients undergoing thoracic surgical procedures will be covered.

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Further Reading

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Author information

Authors and Affiliations

  1. Department of Anesthesia and Perioperative Care, University of California, San Francisco, 521 Parnassus Avenue, Room C-450, San Francisco, CA, 94143-0648, USA

    Lundy Campbell

  2. Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA

    Jeffrey A. Katz

Authors
  1. Lundy Campbell
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  2. Jeffrey A. Katz
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Corresponding author

Correspondence to Lundy Campbell .

Editor information

Editors and Affiliations

  1. Department of Anesthesia and Perioperative Medicine, Emerson Hospital (former faculty Brigham and Women’s Hospital, Harvard Medical School), Concord, Massachusetts, USA

    Paul K. Sikka

  2. Associate Professor, Associate Residency Program Director, Director of Trauma Anesthesiology, Department of Anesthesiology-Presbyterian Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

    Shawn T. Beaman

  3. Chair, Department of Anesthesia and Perioperative Medicine, Emerson Hospital; Associate Professor, Northeastern University, Boston, MA (former faculty Brigham and Women’s Hospital, Harvard Medical School), Concord, Massachusetts, USA

    James A. Street

Clinical Review

Clinical Review

  1. 1.

    Factors decreasing functional residual capacity include all, except

    1. A.

      Change from upright to supine position

    2. B.

      Obesity

    3. C.

      Pregnancy

    4. D.

      Infant compared to an adult

  2. 2.

    The FEV1/FVC ratio is decreased in

    1. A.

      Chronic obstructive pulmonary disease

    2. B.

      Acute respiratory distress syndrome

    3. C.

      Sarcoidosis

    4. D.

      Radiation lung fibrosis

  3. 3.

    Normal mixed venous oxygen saturation is (%)

    1. A.

      60

    2. B.

      75

    3. C.

      90

    4. D.

      100

  4. 4.

    Ciliary transport returns to normal within following weeks after cessation of smoking

    1. A.

      1

    2. B.

      2

    3. C.

      4

    4. D.

      8

  5. 5.

    Hypoxic pulmonary vasoconstriction is inhibited by all of the following, except

    1. A.

      Nitroprusside

    2. B.

      Diltiazem

    3. C.

      Propofol

    4. D.

      Sevoflurane (2 MAC)

  6. 6.

    On initiation of single-lung ventilation with a double-lumen endotracheal tube, high peak airway pressures are seen. Your next step would be to

    1. A.

      Add PEEP to the ventilated lung

    2. B.

      Add CPAP to the non-ventilated lung

    3. C.

      Suction the endotracheal tube to clear any secretions

    4. D.

      Insert a fiberoptic scope

  7. 7.

    In an anesthetized patient in the lateral decubitus position with a closed chest, the

    1. A.

      Nondependent lung is better ventilated and perfused

    2. B.

      The dependent lung is better ventilated and perfused

    3. C.

      The dependent lung is better perfused, and the nondependent lung is better ventilated

    4. D.

      The dependent lung is better ventilated, and the nondependent lung is better perfused

  8. 8.

    High-risk patients for lung resection have all the following parameters, except

    1. A.

      Postoperative predicted FEV1 < 800 ml

    2. B.

      Postoperative predicted diffusion capacity of carbon monoxide of 80 %

    3. C.

      PaO2 less than 50 mmHg

    4. D.

      PaCO2 more than 45 mmHg

  9. 9.

    For mediastinoscopy, the pulse oximeter should be placed on the

    1. A.

      Right hand

    2. B.

      Left hand

    3. C.

      Right or left hand

    4. D.

      Right or left foot

  10. 10.

    For single-lung ventilation, advantage of using a bronchial blocker over a double-lumen tube is

    1. A.

      Patient can be taken to the ICU without changing the endotracheal tube

    2. B.

      Rapid deflation of the lung

    3. C.

      Ease of placement

    4. D.

      Bulky

Answers: 1. D, 2. A, 3. B, 4. D, 5. C, 6. D, 7. C, 8. B, 9. A, 10. A

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Campbell, L., Katz, J.A. (2015). Thoracic Anesthesia. In: Sikka, P., Beaman, S., Street, J. (eds) Basic Clinical Anesthesia. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1737-2_28

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  • DOI: https://doi.org/10.1007/978-1-4939-1737-2_28

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1736-5

  • Online ISBN: 978-1-4939-1737-2

  • eBook Packages: MedicineMedicine (R0)

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