The student will
Correlate physiological comorbidity issues with the anesthesia care plan
List position considerations  specific to these surgical procedures
Describe the use of DLT and general considerations
Identify factors to prevent exacerbation of pulmonary vasoconstriction

CLINICAL Symptom &Signs:Pulmonary hypertension, RVH, Cor Pulmonale
Prominent neck veins, prominent A waves& perhaps prominent V waves on EKG
Prominent left parasternal heave & rocking motion synchronous with heartbeat may be noted
Auscultate: pulmonary component of 2nd heart sound increases
High pitched, early systolic ejection click
Systolic ejection murmur
R-sided atrial S4 gallop indicating inc RVEDP
Middiastolic R-sided S3 gallop, usually clear evidence of impaired RV function.  Differentiated: gallops inc in intensity with

inspiration
Early diastolic, pulmonary regurg murmur ind functional impair secondary to dilation of PA root
Rt heart failure with chronic dependent edema, large tender liver, ascites, dilated distended neck veins

CXR in Pulmonary HTN
Main pulmonary vessels dilated
Characteristic of COPD with hyperinflated lungs, low flat diaphragm
Evidence of RVH; clockwise cardiac rotation, loss of air space behind the sternum on a lateral view

LV DYSFUNCTION CONTRIBUTORS
Hypoxia, hypercarbia, acidosis
CAD/valvular disease
Systemic hypertension
Ventricular interdependence
Alterations in intrathoracic pressure

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