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CVR > Surgery > Flashcards

Surgery Flashcards

1
Q

Who is most at risk going under anaesthetic?

A

Smokers, obese, elderly, malnourished

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2
Q

Smokers

A

Decreased cilial activity
Increased bronchial secretions
Weak immune system
Higher closing volume

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3
Q

Elderly

A

Decreased lung compliance
Stiffer thoracic cage
Reduced effectiveness of thermoregulation- anaesthetic affects re-distribution of body heat, can change core temp by 0.5-1.5 which can be dangerous for elderly. Elderly more likely to drop temp and not recover quickly.

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4
Q

Obese

A

Reduced FRC
Higher CC
Increased effort to move thoracic cage
Poor basal expansion

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5
Q

Effect of upper abdominal surgery

A

Affects diaphragm function

Patient’s won’t want to take deep breaths so at risk for atelectasis

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6
Q

Surgery complications

A 
Pain
Reduced lung volumes- FRC, VC
Retained secretions
Increased work of breathing
Decreased exercise tolerance
Hypoxaemia
Respiratory muscle weakness
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7
Q

Why are the lower lobes most at risk of atelectasis?

A

Because they are the last to receive oxygen especially when in pain

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8
Q

Thrombosis

A

Caused by immobility
Fluid loss
Abnormal clotting
Calf compression

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9
Q

When is generally the greatest reduction in FRC post op?

A

1st/2nd day

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10
Q

Obesity and FRC

A

Massive reduction in FRC post op

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11
Q

Effect of general anaesthetic on respiratory system

A

Reduced lung volumes

Especially FRC

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12
Q

VC and FRC after surgery

A

VC can reduce to 40% of pre op values

FRC can reduce to 70% of pre op values

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13
Q

How long do VC and FRC changes last?

A

5-10 days

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14
Q

Relationship between FRC and closing capacity (CC)

A

FRC normally exceeds CC, so small airways stay open at end of quiet expiration.
But if FRC falls below CC or CC rises above FRC, this could result in V/Q mismatch and hypoxaemia.

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15
Q

What are 2 inevitable consequences of major surgery?

A

Post op hypoxaemia and atelectasis

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16
Q

How can we counter these consequences?

A

Early upright positioning and mobilization

Because this will optimize FRC

17
Q

Post op pulmonary complications can cause…

A

Post op morbidity and mortality.

Increased length of stay.

18
Q

PPC risk factors

A 
Anaesthesia duration greater than 180 minutes
Type of surgery- upper abdominal
Current smoking (within last 8 weeks)
Presence of pre op respiratory problems
Reduced level of pre op activity
Sleep apnoea
Advanced age
19
Q

What can exacerbate post op changes such as impaired respiratory fucntion?

A

Obesity

20
Q

Positioning after pneumonectomy

A

Positioned onto operated side so remaining lung is uppermost

21
Q

What is a serious complication of pneumonectomy?

A

Pulmonary oedema

Look for a positive fluid balance, with tachycardia, tachypnoea and hypoxaemia

22
Q

Positioning after oesophageal surgery

A

Avoid head down positioning
To prevent gastric reflux which can lead to aspiration
Avoid neck extension

23
Q

Positioning after lobectomy and pleurectomy

A

Side lying and head down has no contraindication

24
Q

Thoracic surgery and positive pressure therapies

A

With caution or not at all

25
Q

Management of sternal and rib fractures

A

Requires effective pain relief to prevent hypoventilation

Ensure they can take a deep breath

26
Q

Flail chest

A

Where 2 or more ribs are fractured in 2 or more places leading to a floating segment
Causes severe pain and increased WOB which can lead to respiratory failure due to poor ventilation of underlying lung.

27
Q

Treatment for flail segment

A

CPAP

28
Q

Effect of prolonged recumbency

A

Reduces ventilation to lung bases, causes poling of intra-thoracic blood to these regions which upsets V/Q.

29
Q

Cause of brief post op hypoxaemia

A

Due to anaesthetic

Requires brief oxygen therapy

30
Q

Cause of post op hypoxaemia for several days

A

Related to the surgery

Major surgery requires post op oxygen therapy for at least 72 hours

31
Q

What is common after CV surgery?

A

Atrial fibrillation

Usually second day

32
Q

Melbourne group scale

A

PPC diagnosed with four of more of:
CXR shows atelectasis/consolidation
Fever with raised temp
WCC of more than 11.2
SpO2 less than 90% on room air
Production of yellow/green sputum differing from preop status
Signs of infection on microbiology
Diagnosis of pneumonia or chest infection by attending physician
Readmission to ICU with respiratory problems or >36 hours stay in ICU or abnormal breath sounds differing to pre op status

33
Q

Incidence of atelectasis

A

0-5% in lower abdominal surgery
19-59% in thoracic surgery
88% in upper abdominal surgery.

CVR (20 decks)

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