Respiratory and Thoracic Anesthesia Flashcards

During thoracic surgery in the lateral decubitus position, the dependent lung has INCREASED perfusion because of:

Answer: Gravity-dependent redistribution of pulmonary blood flow

Gravity directs more blood flow to the dependent (down) lung in the lateral position, creating the basis for matched ventilation and perfusion during two-lung ventilation.

A 45-year-old woman scheduled for left VATS lobectomy has a predicted postoperative FEV1 of 52% and DLCO of 55%. According to ESTS guidelines, her surgical risk category is:

Answer: Low risk — no further testing required

Both predicted postoperative FEV1 and DLCO >40% place the patient in the low-risk category, and surgery may proceed without mandatory CPET.

Which of the following most accurately describes the physiological effect of opening the chest during thoracotomy on the non-paralyzed patient breathing spontaneously?

Answer: Paradoxical movement of the operative lung causing mediastinal swing

In the awake spontaneously breathing patient, opening the chest causes the operative lung to collapse on inspiration and expand on expiration (paradoxical), with the mediastinum shifting toward the closed side.

Which drug should be AVOIDED when treating HPV inhibition-related hypoxemia during OLV?

Answer: IV nitroglycerin

Nitroglycerin is a pulmonary vasodilator that inhibits HPV systemically, worsening hypoxemia by increasing blood flow to the non-ventilated lung.

The 'difficult airway' encountered during planned fiberoptic intubation for thoracic surgery is best managed by which backup strategy according to the DAS guidelines?

Answer: Supraglottic airway (LMA) insertion followed by fiber-optic intubation through it

DAS guidelines recommend a second-generation supraglottic airway as a rescue device; fiberoptic intubation through the LMA can then establish a definitive airway.

Intraoperative massive hemoptysis (>150 mL) during bronchoscopy for lung cancer staging is best immediately controlled by:

Answer: Immediate isolation of the bleeding lung with a DLT or bronchial blocker

Protecting the non-bleeding lung from blood aspiration by rapid lung isolation is the immediate priority to prevent bilateral flooding and asphyxiation.

A patient is extubated after right upper lobectomy but develops progressive dyspnea 6 hours later with tracheal deviation to the right. Chest X-ray shows a large right pleural opacity. The diagnosis is:

Answer: Hemothorax from a bleeding intercostal vessel

Tracheal deviation toward the operative side with a pleural opacity after lobectomy indicates hemothorax compressing the remaining right lung, consistent with uncontrolled bleeding.