Mod 7c- resp disease

Question 1

Which 2 life threatening conditions can anaesthesia precipitate

Answer 1

aspiration pneumonitis, bronchospasm

Question 2

What is the functional residual capacity?

Answer 2

volume of air left in the lungs at end of normal expiration. Sum of residual and expiratory reserve volumes

Filled with 21% O2

Question 3

What can decreased FRC in anaesthesia

Answer 3

Supine position
Intubation
All anaesthetic agents
Muscle relaxants, immobility
Surgical retractors
Oxygen and Nitrous oxide (N2O)
Abdominal masses: Obesity, tumours, pregnancy, ascites

Question 4

What are the 3 common resp diseases encountered in anaesthesia

Answer 4

Obstructive diseases: COPD, asthma

Restrictive lung diseases

Infections: pneumonia, TB, COVID-19, Bronchiectasis

Question 5

What are the anaesthetic implications of asthma?

Answer 5

If poorly controlled, triggers fatal bronchospasm

Question 6

What can be done to prevent bronchospasm in asthmatic

Answer 6

assess patient thoroughly: symptoms and signs, triggers, flare-ups, admission, effort tolerance+ meds

Lung function testing: pre and post bronchodilator FEV1/FVC ratio. IF >12% / 200ML IMPROVEMENT-> SUBOPTIMALLY TREATED

Question 7

How do you manage an asthmatic in anaesthesia

Answer 7

pre-operative optimization:
- B2 agonist, steroids

Avoid histamine releasing drugs and NSAIDS

Minimise airway irritation:
- LMA vs ETT
- Volatiles produce bronchodilatation
- Extubate deep

Question 8

What is the management of acute bronchospasm under anaesthesia

Answer 8

give high concentration of O2

Deepen anaesthetic(volatiles)

Bronchodilator therapy:
- salbutamol into anaesthetic circuit, IV B2 agonists, aminophyline
- Adrenaline(inhaled/dilute into IV)

Ketamine, MgSO4

Question 9

What mus be included in perioperative assessment of COPD?

Answer 9

Hx:
- effort tolerance
- sputum production
- recent flare-ups

Exam:
- clinical
- Lung functions
- CXR
- ABG

Question 10

Anaesthetic manage of COPD include?

Answer 10

optimise preoperatively
continue regular therapy
rpotect airway from secretions
ETT rather than LMA in GA
Avoid bronchospasms
Avoid GA if possible-> regional

Question 11

How is restrictive lung disease characterized

Answer 11

dyspnoiec, small tidal volumes

Question 12

What must you be careful for in restrictive lung disease

Answer 12

be careful of regional anaesthesia-> block the accessory muscles

Question 13

What must be done in acute pneumonia

Answer 13

avoid anaesthesia, emergencies only

Question 14

What must be done in PTB?

Answer 14

avoid hepatotoxic drugs
contact precautions

Question 15

What must be done in covid-19

Answer 15

airway management is hazardous

Question 16

What must be done for bronchiectasis?

Answer 16

Pre-op physio
*Postural drainage
*Antibiotics