Order Level Of Oxygen Saturation Discussion

Order Level Of Oxygen Saturation Discussion
1. Which of the following is an absolute indication for OLV with a DLT as
opposed to a bronchial blocker?
A. Need for independent lung ventilation in a patient with severe unilateral rib
fractures
B. Wedge resection
C. Pneumonectomy
D. Lobectomy
2. During VAT wedge resection for a right lower lobe tumor with a bronchial
blocker, the patient develops increased peak airway pressures, hypoxia, and a
decreased end-tidal carbon dioxide. The surgeon reports good lung isolation in
the field. Which of the following is the appropriate next step?
A. Fiberoptic evaluation of the bronchial blocker
B. Deflation of the bronchial blocker and ventilation of both lungs
C. Needle decompression of dependent lung
D. Application of CPAP to operative lung
3. During right middle lobe resection for adenocarcinoma, you notice that your
patient appears to be developing a mild acidosis on arterial blood gas. pH is
7.22, lactic acid is mildly elevated, hemoglobin is 10.1, urine output has been
0.5 mL/kg/h for the past 3 hours, and estimated blood loss is 150 mL. Which of
the following is the best next step?
A. Start low-dose inotropes.
B. Give a fluid bolus of 10 mL/kg.
C. Transfuse 1 unit of packed red blood cells.
D. Increase minute ventilation to correct the acidosis.
4. 13. Which level of oxygen saturation (SpO2
) is acceptable for a patient
undergoing OLV?
A. 92%
B. 90%
C. 80%
D. 76%
5. Which gas mixture is associated with the highest incidence of postthoracotomy
atelectasis?
A. 98% O2
/2% sevoflurane
B. 60% O2
/33% air/7% desflurane
C. 50% O2
/49% air/2% isoflurane
D. 28% O2
/70% nitrous oxide/2% sevoflurane
6. A patient who has a history of bleomycin chemotherapy for testicular cancer is
undergoing a left VAT surgery for metastasis. The patient begins to desaturate
to 88% with stable hemodynamics. Which of the following is the most
appropriate next step?
A. Attempt recruitment maneuver of dependent lung.
B. Resume two-lung ventilation.
C. Increase the fraction of inspired oxygen.
D. Increase positive end-expiratory pressure (PEEP) of the dependent lung.
7. A patient is undergoing surgery for correction of a bronchopleural fistula. A
DLT has been placed without difficulty. During the procedure, the patient’s
oxygen saturation decreases to 85%. Which of the following is the most
appropriate next step?
A. Apply CPAP to the operative lung.
B. Increase the fraction of inspired oxygen.
C. Fiberoptic confirmation of DLT placement.
D. Resume two-lung ventilation.
8. A patient is scheduled to undergo a bilateral thoracoscopic MAZE procedure
for chronic atrial fibrillation. The procedure is to be performed in the supine
position. Which of the following interventions will reduce the likelihood of
desaturation during OLV?
A. Operating on the right side first
B. Use of a total intravenous anesthetic
C. Use of a right-sided DLT
D. Use of a tidal volume of 10 mL/kg to maintain lung inflation
9. A patient has persistent pain in the posterior and lateral aspects of the shoulder
10 days following thoracotomy. Which of the following positioning errors that
can occur during the surgery is the most likely mechanism for this patient’s
pain?
A. Inadequate padding of the dependent chest wall
B. Lateral flexion of the cervical spine
C. Placement of the axillary roll in the axilla
D. Oversupination of the suspended arm
10. In which of the following patients would the administration of PEEP be
expected to improve oxygenation during OLV?
A. A 68-year-old man with severe emphysema on tiotropium undergoing lobectomy
B. A 34-year-old man with α1 antitrypsin deficiency undergoing wedge resection
C. A 51-year-old woman with moderate COPD on pulmonary function tests (PFTs)
undergoing pleurectomy for mesothelioma
D. A 42-year-old woman with interstitial lung disease undergoing VAT wedge
resection
20. 20. A 70-kg, 1.8-m tall man is scheduled for open thoracotomy/sleeve resection
for adenocarcinoma of the lung. Preoperative PFTs are within normal limits,
and the patient denies any smoking history. A right-sided DLT is placed
uneventfully after induction of anesthesia. Which of the following ventilation
strategies is most appropriate?
A. Volume control with a tidal volume of 700 mL, respiratory rate of 10, PEEP of 0
B. Volume control with a tidal volume of 800 mL, respiratory rate of 8, PEEP of 5
C. Volume control with a tidal volume of 450 mL, respiratory rate of 14, PEEP of 5
D. Volume control with a tidal volume of 750 mL, respiratory rate of 12, PEEP of 8
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