Pneumonectomy Elisha 18

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What is the most common cause of cancer-related death in both men and women in the United States?

Lung cancer (correct)

Breast cancer

Prostate cancer

Skin cancer

Which pulmonary resection procedure is considered to be a more extensive form of surgery?

Completion pneumonectomy

Lobectomy

Segmentectomy (wedge resection)

Pneumonectomy (correct)

What is the primary purpose of evaluating pulmonary disease, cardiovascular disease, and comorbidities during preoperative assessment?

To determine the patient's age

To decide on the surgical technique

To select the type of anesthesia

To assess the patient's ability to tolerate lung resection surgery (correct)

Which factor influences the need for advanced intraoperative monitoring during lung cancer surgery?

Histologic type of lung cancer Signup and view all the answers

What is the primary purpose of one-lung ventilation (OLV) during lung surgery?

To separate the lungs for optimal surgical visualization Signup and view all the answers

Which method can be used to achieve one-lung ventilation (OLV) during lung surgery?

Dual-lumen endobronchial tube (ETT) Signup and view all the answers

What is the most common cause of cancer-related deaths in the United States, according to the text?

Lung cancer Signup and view all the answers

Which type of lung carcinoma accounts for 25% of all lung cancer cases?

Oat-cell carcinoma Signup and view all the answers

Why is surgery rarely involved in the treatment of small-cell lung carcinoma (SCLC), according to the text?

Metastases have frequently occurred upon initial evaluation Signup and view all the answers

What is the second most common type of lung carcinoma after small-cell lung carcinoma (SCLC), based on the text?

Adenocarcinoma Signup and view all the answers

What proportion of patients presenting with lung cancer are nonsmokers, according to the text?

Less than 10% Signup and view all the answers

Which environmental exposure can often contribute to the development of lung cancer in nonsmokers?

Heavy metal exposure Signup and view all the answers

Which surgical procedure involves making a posterolateral or lateral thoracotomy incision through the fifth intercostal space?

Extra pericardial pneumonectomy Signup and view all the answers

What is the primary purpose of the surgeon performing a methodical biopsy of the thoracic lymph nodes during a pneumonectomy procedure?

To assess the extent of lymph node involvement Signup and view all the answers

What is a potential disadvantage of performing a video-assisted thoracoscopic (VATS) approach for pneumonectomy compared to open thoracotomy?

Limited visualization and limited ability for the surgeon to manually compress the lung Signup and view all the answers

What is the primary reason the surgical ligation of the hilar structures (pulmonary artery, pulmonary veins, and bronchus) is performed during a pneumonectomy?

To prevent unwarranted damage to major vascular and mediastinal structures Signup and view all the answers

What is the primary advantage of using a double-lumen endotracheal tube (ETT) compared to a bronchial blocker during a VATS procedure?

Easier control of lung isolation Signup and view all the answers

What is the primary reason that VATS can be performed using epidural anesthesia in the spontaneous breathing patient who is sedated?

To manage cases of severe pulmonary compromise Signup and view all the answers

What is the purpose of performing surgical evaluation of the thoracic cavity, mediastinum, pulmonary parenchyma, and pleural surfaces during the extra pericardial pneumonectomy procedure?

To identify metastases and lymph node involvement Signup and view all the answers

Why is partial or total rib resection sometimes necessary during extra pericardial pneumonectomy?

To facilitate visualization during the surgery Signup and view all the answers

What determines whether a pneumonectomy is necessary or if a less dramatic pulmonary resection procedure can be performed in extra pericardial pneumonectomy?

The pathological findings of the patient Signup and view all the answers

During extra pericardial pneumonectomy, what structures are surgically ligated at the pulmonary hilum?

Pulmonary artery, pulmonary veins, and bronchus Signup and view all the answers

What would preclude a complete resection in extra pericardial pneumonectomy?

Metastases and mediastinal involvement Signup and view all the answers

After the surgical ligation of hilar structures in extra pericardial pneumonectomy, what is the next step performed by the surgeon?

Extracting the affected lung through the thoracotomy incision Signup and view all the answers

What is the primary purpose of preoperative bronchoscopy and mediastinoscopy examination in patients with bronchogenic carcinoma?

Obtaining biopsies from tracheobronchial pathology Signup and view all the answers

What is a crucial factor in determining a patient's ability to tolerate pneumonectomy?

Cardiac function optimization Signup and view all the answers

Why is preoperative optimization important for high-risk patients undergoing pneumonectomy?

To manage conditions that predispose patients to postoperative complications Signup and view all the answers

What is a common manifestation of SCLC cells derived from neuroendocrine tissue?

Paraneoplastic neurologic syndromes Signup and view all the answers

What is a significant aim of pulmonary optimization procedures before pneumonectomy?

Decreasing viscosity of secretions Signup and view all the answers

What do right and/or left ventricular dysfunctions indicate in patients presenting for pneumonectomy?

The necessity for preoperative optimization Signup and view all the answers

Which of the following is NOT a common structure found in the left and right pulmonary hila?

Azygos vein Signup and view all the answers

Which of the following is NOT a potential advantage of performing a video-assisted thoracoscopic (VATS) approach for pneumonectomy compared to open thoracotomy?

Improved ability for the surgeon to manually compress the lung Signup and view all the answers

Which of the following is NOT a potential risk associated with pneumonectomy due to the proximity of the pulmonary hila to major vascular and mediastinal structures?

Damage to the diaphragm Signup and view all the answers

Which of the following preoperative tests is LEAST likely to provide accurate information regarding tumor size, location, density, and metabolic activity?

Chest radiograph Signup and view all the answers

Which of the following statements is TRUE regarding the physiological impact of a right-sided pneumonectomy compared to a left-sided pneumonectomy?

A right-sided pneumonectomy results in a greater decrease in total lung area. Signup and view all the answers

Which of the following statements regarding the use of epidural anesthesia for VATS procedures is INCORRECT?

It requires sedation in addition to the epidural anesthesia Signup and view all the answers

Which factor is NOT a consideration when choosing between a left-sided and right-sided double-lumen endotracheal tube (DLT) for a surgical procedure involving the mainstem bronchus?

Gender of the patient Signup and view all the answers

What is a contraindication for using a right-sided double-lumen endotracheal tube (DLT)?

Anomalous right upper lobe orifice above the tracheal carina Signup and view all the answers

When selecting the ideal size of a double-lumen endotracheal tube (DLT), what is NOT a consideration?

Length of the patient's neck Signup and view all the answers

How is placement confirmed for a bronchial blocker?

Chest radiograph, clinical signs, and fiber-optic bronchoscopy Signup and view all the answers

What can contribute to inadequate ventilation of the right upper lobe with a right-sided double-lumen endotracheal tube (DLT)?

Obstruction of the right mainstem bronchus Signup and view all the answers

For confirming placement of a double-lumen endotracheal tube (DLT), which method has shown a significant incidence of mispositioning despite proper positioning based on clinical signs?

Fiber-optic bronchoscopy Signup and view all the answers

What technique can be used during placement to ensure adequate ventilation of the right upper lobe with a right-sided double-lumen endotracheal tube (DLT)?

(4) Ventilation slot embedded in the endobronchial cuff Signup and view all the answers

In what scenario should the choice between a left- and right-sided double-lumen endotracheal tube (DLT) be carefully considered?

(4) Surgical procedures involving the mainstem bronchus Signup and view all the answers

Which of the following types of pneumonectomy involves the removal of the entire lung, ipsilateral pleura, hemopericardium, and hemidiaphragm?

Radical pneumonectomy (extrapleural pneumonectomy) Signup and view all the answers

What is the primary purpose of performing a carinal pneumonectomy?

To remove the entire lung, ipsilateral mainstem bronchus, and carina Signup and view all the answers

What is the primary factor that determines the type of pneumonectomy selected for a patient with lung carcinoma?

The type, stage, and location of the lung carcinoma Signup and view all the answers

What is the primary reason for performing a completion pneumonectomy?

To remove the affected lung after a previous lung resection has experienced a recurrence of carcinoma Signup and view all the answers

Which of the following statements accurately describes the difference between intrapericardial and extrapericardial pneumonectomy?

Intrapericardial and extrapericardial pneumonectomy refer to a standard pneumonectomy with the extent of surgical resection in relation to the cardiac pericardium Signup and view all the answers

What is the primary purpose of performing one-lung ventilation (OLV) during lung surgery?

To improve surgical visibility by collapsing the operative lung Signup and view all the answers

What does pulmonary compliance refer to?

The change in volume for a given change in pressure in lung tissue Signup and view all the answers

What causes a mismatch of ventilation and perfusion in the dependent lung during a lateral decubitus position?

Decreased perfusion in the dependent lung Signup and view all the answers

In the lateral decubitus position, why do the dependent lung regions function similarly to the inferior regions of the upright lung?

Due to a decrease in pulmonary compliance Signup and view all the answers

How do regional differences in pleural pressure affect ventilation in the lung?

They result in increased ventilation in superior areas Signup and view all the answers

What causes a relative increase in ventilation in the nondependent lung during controlled ventilation?

Decreased pulmonary compliance Signup and view all the answers

How does regional differences in pleural pressure affect tidal volume distribution?

It decreases tidal volume in superior areas Signup and view all the answers

Why is there a mismatch of ventilation and perfusion in the dependent lung during anesthesia?

Decreased pulmonary compliance Signup and view all the answers

What happens to pulmonary compliance in the dependent lung during thoracotomy (open chest surgery)?

Decreases Signup and view all the answers

What is the result of regional differences in pleural pressure on ventilation?

Increased tidal volume distribution towards inferior portions of the lungs compared to superior portions Signup and view all the answers

What occurs when there is a relative increase in ventilation due to regional differences between the superior and inferior portions of the lungs?

Increased compliance leading to better gas exchange capacity Signup and view all the answers

What is the primary purpose of hypoxic pulmonary vasoconstriction (HPV) during instances of hypoxia?

To decrease pulmonary vascular resistance Signup and view all the answers

Which pharmacologic agent used in anesthesia has been implicated in inhibiting hypoxic pulmonary vasoconstriction (HPV)?

Inhalation anesthetics Signup and view all the answers

Why is it important to avoid factors that inhibit hypoxic pulmonary vasoconstriction (HPV) during permissive atelectasis?

To maximize oxygenation Signup and view all the answers

How does continuous positive airway pressure (CPAP) applied to the non-ventilated lung help during one-lung ventilation?

By minimizing alveolar hypoventilation Signup and view all the answers

What is the primary benefit of a tidal volume set to approximately 4 to 6 mL/kg during one-lung ventilation?

Preventing atelectasis Signup and view all the answers

What is a potential risk associated with applying positive-end expiratory pressure (PEEP) greater than 5 mm Hg during one-lung ventilation?

Raising pulmonary vascular resistance Signup and view all the answers

Why should the amount of drug administered be considered during the use of pharmacologic agents that may inhibit hypoxic pulmonary vasoconstriction (HPV)?