COPD

QUESTION 1: A patient with obstructive lung disease has an altered anesthetic induction with an insoluble agent because of:
A. decreased cardiac output
B. increased perfusion
C. increased PCO2
D. uneven ventilation
E. decreased minute volume

QUESTION 2: A patient has chronic obstructive pulmonary disease requiring the constant administration of oxygen.  He is dypsneic at rest and can walk at the most 20 feet before needing to rest.  He is scheduled to undergo an exploratory laparotomy because of small bowel obstruction.  He would be classified by the American Society of Anesthesiologists as a physical status:
A. III
B. IIIE
C. IVE
D. V
E. VE

Here's your COPD patient.  Have fun intubating him!

(Beards are wierd)

ANSWER 1: (D) The patient with chronic obstructive lung disease has a prolonged induction due to ventilation/perfusion mismatching.  The cardiac output is usually not decreased.  The increased PCO2 does not directly affect the uptake of the agent.  Decreased minute ventilation is not a factor.

ANSWER 2: (C) This patient would be classified as physical status IV because he has an incapacitating systemic illness.  Because the patient is to undergo an emergency procedures, "E" is added to the physical status.

REFERENCES:

McGraw-Hill Specialty Board Review