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Anaesthesiology > LUNG AND ANAESTHESIA > Flashcards

LUNG AND ANAESTHESIA Flashcards

1
Q

How do we diagnose COPD in a patient?

A
  1. Strong smoking history
  2. Chronic cough
  3. Long expiration >6s
  4. Wheezing on expiration
  5. Right heart failure
  6. Signs of hypercarbia
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2
Q

Can we do elective surgery if there is active bronchospasm?

A

No

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3
Q

What are the predictors of risk for post-operative pulmonary complications?

A
  1. Over 60
  2. Smoking in the last 6-8 weeks of surgery
  3. Thoracic or upper abdominal surgery
  4. BMI of 27
  5. Abnormal chest X-ray
  6. PaCO2>6kPa, FEV<1L
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4
Q

What are the types of obstructive lung diseases?

A
  • acute-asthma

- chronic-chronic bronchitis, and emphysema

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5
Q

What is emphysema?

A

-destruction and dilatation of the air spaces distal To the respiratory bronchioli

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6
Q

What is the main problem in these patients? Inspiration or expiration and why?

A
  • expiration is the main problem

- the more the patients exhales the more the equal pressure point is compressed

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7
Q

How do we make a diagnosis of chronic bronchitis?

A

-usually diagnosed as a result of sputum production for 3 months a year for 3 years

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8
Q

In regards to chronic bronchitis, what causes the excess sputum?

A

-the hypertrophy of the mucus producing glands

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9
Q

What is the goal for the pre-op assessment for patients with COPD?

A
  • assess the severity
  • develop the anaesthetic plan for the patient
  • manage the comobidities
  • end organ disease
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10
Q

What do you need to do pre-operatively in patients with COPD?

A
  • History, examination
  • side room examination
  • special investigations
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11
Q

What questions do you need to ask in history?

A
  1. how long they had been smoking for
  2. whether they are on treatment-inhalers,steroids
  3. end organ disease(Right heart failure and pulmonary hypertension)
  4. How well controlled they are-ask them to climb two flights of stairs
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12
Q

What special investigations would you do in these patients?

A
  1. Flow volume loop
  2. ECG
  3. CHEST X-ray (look for active infection and right heart failure)
  4. Blood gas test: PaCO2>6kPA
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13
Q

What changes on the ECG would you expect in a patient with right heart failure/cor pulmonale?

A
  • I would expect RBBB
  • p pulmonale
  • right axis deviation
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14
Q

What do we need the patient to do before the operation?

A
  1. stop smoking 4-8 weeks prior to reduce perioperative complications
    Stop smoking 24/48 hrs to help with mucociliary clearance
  2. Chest physiotherapy
  3. Start on antibiotics if active disease
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15
Q

What is important to consider in patients with COPD in regards to premedication?

A
  • It is important to be wary of the use of opiates and benzodiazepines because the. Respiratory depression is more dramatic
  • continue chronic medication
  • consider additional short acting nebs
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16
Q

What is the first thing you need to do in the first 20-30 minutes before anaesthesia=?

A
  1. Give anticholinergic medication intravenously (glycopyrrolate) to block the vagus nerve to prevent bronchoconstriction
17
Q

Which local block do we need to stay away from in order to prevent possible diaphragmatic paralysis?

A

-brachial plexus block

18
Q

What are the effects of anaesthesia on the respiratory function?

A
  1. Functional residual capacity decreases which leads to faster desaturation and increased work of breathing
  2. Atelectasis
  3. inhibited response to PaCO2, PaO2 and acidosis
19
Q

Which IV induction agent is best in this case?

A

-Ketamine or propofol because it has minimal respiratory suppression

20
Q

Which inhalational drugs would you use in COPD?

A
  • sevoflurane
  • isoflurane
  • halothane and avoid desflurane
21
Q

What ventilator settings do you need to place for this patient?

A

-expiratory time on the ventilator must be prolonged
-larger tidal volume
-reduce the number of breaths per time unit
-

22
Q

What do we need to do post-operatively?

A
  • supplemental oxygen or CPAP
  • physiotherapy
  • analgesia
  • early moboilisation
23
Q

What drug is glycopyrrolate?

A

-anticholinergic and is used pre-op in COPD patients to prevent bronchospasm

Anaesthesiology (25 decks)

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