ANESTHESIA BOARD REVIEW UPDATE

ANESTHESIA BOARD REVIEW UPDATE

indications for OLV - INDICATIONS FOR ONE LUNG VENTILATION
Absolute
1. Protective Isolation
a. Massive Hemorrhage
b. Infection
2. Control of Ventilation Distribution
a. Bronchopleural or bronchopleural cutaneous fistula
b. Giant cyst or bullae (risk of rupture with PPV)
c. Major bronchial disruption or trauma
3. Unilateral Lung Lavage
4. VATS
Relative (Strong) - Surgical Exposure
1. Thoracic aortic aneurysm
2. Pneumonectomy
3. Upper lobectomy
Relative (Weak) - Surgical Exposure
1. Esophageal surgery
2. Middle and lower lobectomy
3. Thoracoscopy under general anesthesia
fasting guidelines children -
endocrine- diabetes - ...Complications of diabetes mellitus include coronary artery
disease, cerebrovascular and peripheral vascular disease, autonomic and sensory
neuropathies [cardiovascular and GI effects], and joint stiffness, all of which can affect
the anesthetic. TMJ and cervical joint stiffness (due to glycosylation of tissue proteins)
should be assessed, as 30% of diabetics have difficult intubations
endocrine- diabetes - The most feared complication of diabetes is diabetic ketoacidosis
(DKA), which is most commonly precipitated by an infection. DKA should be treated with
fluid resuscitation, IV insulin (0.2 U/kg initially, 0.1 U/kg/hr after, goal is to decrease by
75-100 mg/dL or 10% per hour), and K+ supplementation (some, but not all, authors
recommend bicarbonate if pH is 7.2)
Autonomic neuropathy develops in ~ 1/3 of diabetics (50% of those with coexisting
hypertension) and may manifest as orthostatic hypotension, reduced HR variability,
baseline tachycardia (decreased inhibitory input), deep breathing, and prolonged QT
interval. Patients with the above symptoms may be at increased risk for sudden death
[Charlson ME et al. JACS 179: 1, 1994], and bradycardia non-responsive to atropine
has been described in diabetic surgery patients [Burgos et al. Anesthesiology 70: 591,
1989]