Pulmonary Pre-Op

Question 1

Major categories of clinically significant post-op pulmonary complications

Answer 1

• Atelectasis
• Infection (bronchitis, pneumonia)
• Respiratory failure (mechanical ventilation for >48 hours after surgery or unplanned reintubation)
• Hypoxemia
• Exacerbation of underlying COPD or asthma

Question 2

Tests and indications

Answer 2

• PFTs
• Chest radiograph
• Cardiopulmonary exercise training (CPET)

Question 3

PFTs should be obtained in patients with

Answer 3

• Uncharacterized dyspnea
• Exercise intolerance
• COPD or asthma (if clinical eval cannot determine if airflow obstruction has been reduced)

Question 4

A chest radiograph within the past six months is reasonable in patients undergoing high risk surgery who are

Answer 4

• Over age 50 years

- Cardiac or pulmonary disease suggested by clinical eval

Question 5

Cardiopulmonary exercise testing (CPET) is used for

Answer 5

• Pt w/ abnormal PFTs (determine safety of planned lung resection surgery)
• Evaluation of pt w/ unexplained dyspnea undergoing major surgery
• A six-minute walk test (easily performed in an office setting, simpler alternative)

Question 6

Strategies to reduce pulmonary complications

Answer 6

• Smoking cessation
• Bronchodilator therapy (COPD) and glucocorticoids
• Systemic glucocorticoids for poorly controlled asthma (rapid beta agonist 30 min before intubation if needed)

Question 7

For patients taking prednisone > 20 mg/day or its equivalent for more than three weeks

Answer 7

• Stress-dose glucocorticoids should be administered prior to anesthesia

Question 8

Procedures that are less invasive and of shorter duration generally carry

Answer 8

• Less risk for postoperative pulmonary complications

- Regional anesthesia (nerve block) may reduce risk in very high-risk patients

Question 9

Short or intermediate-acting neuromuscular blocking agents

Answer 9

• Cisatracurium
• Mivacurium
• Rocuronium
• Vecuronium
• Less likely to result in hypoventilation and postoperative respiratory failure than longer-acting agents

Question 10

Postoperative interventions that are beneficial for high risk patients include

Answer 10

• Deep breathing exercises, incentive spirometry
• Early mobilization
• Epidural or regional analgesia (nerve block) in place of parenteral opioids