chapter 41. quiz 1 .Respiration and Respiratory Monitoring
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Questions and Answers

What does the ASA Standards for Basic Anesthetic Monitoring emphasize regarding the presence of anesthesia personnel?

  • It is secondary to the information provided by equipment.
  • It mandates the presence of qualified personnel throughout different types of anesthesia. (correct)
  • It should follow the reliance on electronic instrumentation.
  • It does not consider the expertise and interpretation of the anesthesia provider.

    • What does the concept of respiration include?

  • Removal of waste materials from cells
  • Synthesis of ATP by cells
  • Transport of O2 from the environment to body cells and transport of CO2 from body cells to the environment (correct)
  • Production of water in body cells

    • What does respiratory monitoring refer to?

  • Monitoring of blood sugar levels
  • Regulation of body temperature
  • Continuous or periodic assessment of processes related to respiratory gas exchange (correct)
  • Tracking cognitive function in the brain

    • In respiratory monitoring, what is assessed regarding the exchange of gases between the environment and subcellular pathways?

    <p>Convective and diffusive gas transport</p> Signup and view all the answers

    Where does cellular respiration involve the use of O2 and production of CO2?

    <p>Mitochondria</p> Signup and view all the answers

    What is the essential role of the physical examination in perioperative respiratory monitoring?

    <p>It offers crucial details for diagnosis and treatment, often signaling changes in patient status requiring intervention.</p> Signup and view all the answers

    In elective cases, why does the anesthesiologist have the time to investigate causes for abnormal presentations?

    <p>Because the procedure is planned, allowing time for further investigation.</p> Signup and view all the answers

    What should the observation of respiratory distress prompt in terms of anesthetic management?

    <p>Immediate search for specific causes.</p> Signup and view all the answers

    How is respiratory rate correlated with disease severity during certain conditions like sepsis?

    <p>It is significantly correlated with disease severity.</p> Signup and view all the answers

    Which of the following is NOT considered an anatomical sign relevant to respiration during a physical examination?

    <p>Wheezing</p> Signup and view all the answers

    Which of the following is functional element ?

    <p>Difficulty of inspiration and expiration</p> Signup and view all the answers

    Why should neck vein distension be examined in patients with respiratory distress?

    <p>To assess for a potential cardiovascular contribution to respiratory distress</p> Signup and view all the answers

    Why is it important to pay attention to painful respiration in trauma patients?

    <p>To detect signs of flail chest, pericardial tamponade, or tension pneumothorax</p> Signup and view all the answers

    What influences an anesthesiologist's clinical judgment when auscultating the lungs?

    <p>Ambient noise, individual hearing limitations, and stethoscope acoustic properties</p> Signup and view all the answers

    Why is a stethoscope of sufficient quality important in identifying breath sounds?

    <p>To recognize normal and abnormal breath sounds distinctly</p> Signup and view all the answers

    Why is a clear understanding of acoustic mechanisms for various breath sounds essential?

    <p>To ensure an accurate clinical evaluation based on sound characteristics</p> Signup and view all the answers

    What is the formula for calculating arterial O2 content (CaO2) as described in the text?

    <p>(1.34 × SaO2 × Hb) + 0.0031 × PaO2</p> Signup and view all the answers

    What is the normal concentration range of sulfhemoglobin (SHb) under normal circumstances in adult blood?

    <p>Less than 1%</p> Signup and view all the answers

    Which components are highlighted as the major determinants of O2 content in the blood according to the text?

    <p>SaO2 and Hb concentration</p> Signup and view all the answers

    Functional O2 saturation (SaO2) refers to which concept as mentioned in the text?

    <p>amount of O2Hb as a fraction of the total amount of O2Hb and deO2Hb</p> Signup and view all the answers

    What is the O2 binding capacity of Hb as presented in the text?

    <p>1.34 mL/g</p> Signup and view all the answers

    fractional saturation O2 saturation (SaO2) refers to which concept as mentioned in the text?

    <p>amount of O2Hb as a fraction of the total amount of Hb</p> Signup and view all the answers

    Which of the following Hb species is expected to have the lowest concentration under normal circumstances in adult blood?

    <p>Sulfhemoglobin</p> Signup and view all the answers

    What is the typical concentration range of carboxyhemoglobin (COHb) in adult blood under normal circumstances?

    <p>1%-3%</p> Signup and view all the answers

    Which type of Hb has the highest expected concentration under normal circumstances in adult blood?

    <p>Oxygenated Hb</p> Signup and view all the answers

    What is the primary function of methemoglobin (MetHb) in the blood?

    <p>NO transport</p> Signup and view all the answers

    Under normal circumstances, which Hb species is expected to have a concentration closest to that of sulfhemoglobin (SHb) in adult blood?

    <p>Methemoglobin</p> Signup and view all the answers

    How does a high SaO2 differ in its ability to discriminate between normoxic and hyperoxic conditions?

    <p>It cannot differentiate between normoxic and hyperoxic conditions</p> Signup and view all the answers

    How do increase in temperature, PaCO2, and 2,3-DPG concentration affect the O2Hb dissociation curve?

    <p>They shift the curve to the right</p> Signup and view all the answers

    Why is it difficult to determine the partial pressure of oxygen at the higher range of oxygen saturations?

    <p>Because of the nonlinear nature of the O2Hb dissociation curve</p> Signup and view all the answers

    How can 2,3-diphosphoglycerate (2,3-DPG) concentration affect the O2Hb dissociation curve?

    <p>It can shift the curve to the right or left</p> Signup and view all the answers

    Considering the O2Hb dissociation curve, what happens if there is a large numeric change in PaO2 at the flat portion of the curve?

    <p>It has minor consequences on blood O2 content</p> Signup and view all the answers

    Considering the O2Hb dissociation curve, at which point approximately start the flat portion of the curve?

    <p>approximately above 70 mm Hg</p> Signup and view all the answers

    which of the following can shift the curve to the right ?

    <p>Acidosis</p> Signup and view all the answers

    which of the following can shift the curve to the left ?

    <p>Alkalosis</p> Signup and view all the answers

    Based on the absorption spectra in the text, what is the minimum number of wavelengths of light that must be measured to determine the concentrations of all five species of Hb in a blood sample?

    <p>5</p> Signup and view all the answers

    In co-oximetry, which of the following is a primary measurement conducted along with oxygen saturation (SaO2) in a blood sample?

    <p>Concentration of different Hb species</p> Signup and view all the answers

    What does a co-oximeter primarily rely on to determine the concentration of different hemoglobin species in a blood sample?

    <p>Wavelength of light absorbed</p> Signup and view all the answers

    In oximetry, which law is utilized to relate the transmission of light through a solution to the concentration of the solute?

    <p>Beer-Lambert Law</p> Signup and view all the answers

    What is the primary goal of standard pulse oximetry?

    <p>Assessing O2 saturation</p> Signup and view all the answers

    How are SaO2 estimates denoted in pulse oximetry?

    <p>SpO2</p> Signup and view all the answers

    What is the ratio 'R' calculated in conventional pulse oximetry based on?

    <p>Light absorption ratios at two different wavelengths</p> Signup and view all the answers

    What is the significance of using 660 nm and 940 nm wavelengths in pulse oximetry?

    <p>To maximize absorbance differences of O2Hb and deO2Hb</p> Signup and view all the answers

    Why does the FDA recommend specific tolerances for SpO2 measurements?

    <p>To provide accuracy in O2 saturation measurements</p> Signup and view all the answers

    What can reduce the accuracy of SaO2 estimates in pulse oximetry?

    <p>Pulsatility reduction</p> Signup and view all the answers

    What is the recommended root mean square difference between measured values (SpO2) and reference values (SaO2) according to the text?

    <p>≤3.0% for transmittance, wrap and clip pulse oximeter sensors, ≤3.5% for ear clip and reflectance sensors</p> Signup and view all the answers

    What is the accuracy range reported by most manufacturing literature regarding SpO2 values between 70% and 100% based on the text?

    <p>±2% to 3% SpO2</p> Signup and view all the answers

    How are calibration curves for O2 saturation typically developed by manufacturers, as stated in the text?

    <p>By having volunteers breathe hypoxic gas mixtures</p> Signup and view all the answers

    What is the range of SaO2 values typically created during the development of calibration curves for O2 saturation according to the text?

    <p>70% to 100%</p> Signup and view all the answers

    What is the range of accuracy for SpO2 over normal conditions regarding transmittance, wrap, clip, ear clip, and reflectance sensors based on the text?

    <p>2.5% to 3.5% for transmittance, wrap and clip pulse oximeter sensors, 3.0% to 3.5% for ear clip and reflectance sensors</p> Signup and view all the answers

    At which wavelength does deO2Hb have greater light absorption than O2Hb?

    <p>660 nm</p> Signup and view all the answers

    Which hemoglobin species has greater light absorption at 940 nm?

    <p>O2Hb</p> Signup and view all the answers

    What is the primary difference in light absorption between deO2Hb and O2Hb at 660 nm?

    <p>deO2Hb absorbs more light</p> Signup and view all the answers

    In pulse oximetry, which wavelength of light is used for detecting greater absorption by O2Hb than deO2Hb?

    <p>940 nm</p> Signup and view all the answers

    What is the primary difference between transmission pulse oximetry and reflectance pulse oximetry?

    <p>The placement of the emitter and detector</p> Signup and view all the answers

    What has pulse oximetry been defined as by the World Federation of Societies of Anaesthesiologists and the WHO?

    <p>A mandatory intraoperative monitoring standard</p> Signup and view all the answers

    What do multiwavelength pulse oximeters allow for?

    <p>Continuous noninvasive monitoring of total hemoglobin concentration and MetHb and COHb</p> Signup and view all the answers

    In what clinical settings has SpHb shown reasonable bias and precision?

    <p>Surgical and ICU settings</p> Signup and view all the answers

    What is the role of photodetector in a pulse oximeter?

    <p>To measure transmission of light at different wavelengths</p> Signup and view all the answers

    What is a limitation of SpHb mentioned in the text?

    <p>It lacks precision at low oxygen levels.</p> Signup and view all the answers

    Why have noninvasive COHb measurements not replaced laboratory measurements?

    <p>They are unreliable for COHb measurements below 87% SaO2.</p> Signup and view all the answers

    What is the advantage of pulse oximetry-based MetHb measurements with a newer device under hypoxic conditions?

    <p>They can detect MetHb accurately even in hypoxic situations.</p> Signup and view all the answers

    Why is universal pulse oximetry recommended for screening newborns by the US Health Secretary?

    <p>To screen for critical congenital heart disease.</p> Signup and view all the answers

    What percentage of critical congenital heart disease lesions can be identified when using a clinical algorithm based on SpO2 levels and routine screening?

    <p>75%</p> Signup and view all the answers

    What did the modality combination of SpO2 levels and newborn physical examination screening lead to?

    <p>A total of 75% sensitivity in suspected cases.</p> Signup and view all the answers

    What is the historical term used to refer to the pulsatile component of light absorption by tissue in pulse oximetry?

    <p>AC (&quot;alternating current&quot;)</p> Signup and view all the answers

    Which term refers to the nonpulsatile component of light absorption by tissues in pulse oximetry?

    <p>DC (&quot;direct current&quot;)</p> Signup and view all the answers

    What is the challenge in obtaining arterial O2 saturation in vivo when compared with in vitro oximetry?

    <p>Avoiding tissue light absorption</p> Signup and view all the answers

    How do changes in blood volume affect the photoplethysmographic trace?

    <p>Changes the rhythm of the trace</p> Signup and view all the answers

    What factor affects the plethysmographic trace during anesthesia according to the text?

    <p>The distensibility of the vessel wall</p> Signup and view all the answers

    What variable has been shown to predict fluid responsiveness in mechanically ventilated patients based on the text?

    <p>Plethysmographic waveform amplitude variation</p> Signup and view all the answers

    What index incorporated into a pulse oximeter quantifies amplitude variation during a respiratory cycle?

    <p>Pleth Variability Index (PVI)</p> Signup and view all the answers

    What condition compromises the accuracy of photoplethysmography for predicting fluid responsiveness?

    <p>Presence of cardiac arrhythmias</p> Signup and view all the answers

    In which patients' group has photoplethysmography been shown to have greater reliability for fluid responsiveness?

    <p>Mechanically ventilated patients</p> Signup and view all the answers

    In which patients' group has photoplethysmography been shown to have greater reliability for fluid responsiveness?

    <p>better for 500 mL fluid challenges</p> Signup and view all the answers

    Goal-directed fluid management based on PVI has been shown to improve outcomes in ? major abdominal surgery.

    <p>major abdominal surgery.</p> Signup and view all the answers

    What can significantly affect the accuracy of SpO2 measurements?

    <p>Low SaO2</p> Signup and view all the answers

    What condition can prevent the detection of hyperoxia with SpO2?

    <p>High SaO2</p> Signup and view all the answers

    What is important for correct interpretation of SaO2 and PaO2 according to the text?

    <p>Knowledge of the individual Hb dissociation curve</p> Signup and view all the answers

    Pulse oximetry does not provide information about which critical parameter?

    <p>tissue oxygenation</p> Signup and view all the answers

    Which of the following can lead to inaccuracies in pulse oximeter readings?

    <p>Presence of intravascular dyes</p> Signup and view all the answers

    What does evidence suggest about the use of pulse oximetry in patient outcomes?

    <p>Reduces the incidence of hypoxemia</p> Signup and view all the answers

    What is the effect of systematic errors in SpO2 as SaO2 falls below 90%?

    <p>They tend to increase</p> Signup and view all the answers

    How does the presence of other Hb variants affect the accuracy of SpO2 measurement?

    <p>It significantly affects accuracy</p> Signup and view all the answers

    At SaO2 levels under 70%, what bias can be observed in the SpO2 value based on the pulse oximeter manufacturer?

    <p>positive or negative bias</p> Signup and view all the answers

    What level of SaO2 indicates limited accuracy for pulse oximeters based on experimental calibration data?

    <p>Below 70%</p> Signup and view all the answers

    what is the effect of motion artifact on SpO2 ?

    <p>Decreased saturation levels</p> Signup and view all the answers

    At what systolic blood pressure level may erroneous SpO2 reductions be observed?

    <p>Below 80 mm Hg</p> Signup and view all the answers

    What could lead to inaccuracy of SpO2 values With continued clinical use?

    <p>Degradation of LEDs in the probe</p> Signup and view all the answers

    What would be the expected SpO2 range in a patient with methemoglobinemia?

    <p>80-85%</p> Signup and view all the answers

    How does the presence of severe cases of sulfhemoglobinemia affect SpO2 readings based on the text?

    <p>Results in a SpO2 value of 85%</p> Signup and view all the answers

    In a patient with carbon monoxide poisoning, how is SpO2 affected according to the information provided?

    <p>SpO2 will be falsely elevated</p> Signup and view all the answers

    Which hemoglobin species has the highest light absorption at 660 nm?

    <p>Sulfhemoglobin (SHb)</p> Signup and view all the answers

    Why may additional clinical laboratory testing be necessary for patients suspected of having sulfhemoglobinemia?

    <p>Most co-oximeters cannot detect SHb</p> Signup and view all the answers

    What can cause venous O2Hb saturation to be detected by the pulse oximeter, leading to a reduction in the measured arterial SpO2?

    <p>Severe tricuspid regurgitation</p> Signup and view all the answers

    What does the absorption of light at 660 nm by COHb result in when compared to O2Hb?

    <p>Similar absorption</p> Signup and view all the answers

    What is a factor that may result in pulse oximeter errors due to venous pulsations despite the lack of hypoperfusion?

    <p>Adhesive finger probe placement on healthy skin</p> Signup and view all the answers

    What can cause an underestimation of arterial O2 saturation in anemic patients ?

    <p>Presence of hypoxia</p> Signup and view all the answers

    Which type of Hb variants has a reduced affinity for O2 and leads to appropriate changes in SaO2 and SpO2 readings?

    <p>Hb Canabiere</p> Signup and view all the answers

    What effect does the administration of methylene blue have on SpO2 readings?

    <p>Transient decrease to 65%</p> Signup and view all the answers

    In patients with sickle cell disease, what physiological change in Hb occurs during hypoxia?

    <p>Low O2 affinity</p> Signup and view all the answers

    Which variant of Hb has altered absorption spectra, resulting in low SpO2 readings with normal SaO2?

    <p>Hb Bonn</p> Signup and view all the answers

    When considering pulse oximetry readings in sickle cell disease patients, what can result in inaccurately high SpO2 values?

    <p>Elevated fetal Hb</p> Signup and view all the answers

    Which nail polish colors can have the greatest effect on SpO2 readings?

    <p>Black, purple, and dark blue</p> Signup and view all the answers

    What does increased skin pigmentation lead to in terms of SpO2 estimates?

    <p>Overestimation of SaO2</p> Signup and view all the answers

    In the presence of severe hyperbilirubinemia, what may result in more accurate SpO2 measurements?

    <p>Falsely low fraction of oxygenated hemoglobin due to MetHb and COHb increase</p> Signup and view all the answers

    How might the placement of the probe interfere with SpO2 readings when using pulse oximetry?

    <p>Allow direct detection of LED light</p> Signup and view all the answers

    How does the accuracy of SpO2 readings vary in patients with continuous flow ventricular assist devices?

    <p>No SpO2 measurements possible</p> Signup and view all the answers

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