Upper and lower respiratory tract infections

Question 1

What are the potential complications of performing an Anaesthetic in a child with an URTI

Answer 1

Airway reactivity - laryngospasm/bronchospasm (coughing and breath holding) and oxygen desaturation.

Question 2

What is the problem with postponing all kids with URTI

Answer 2

Some kids have up to 8 URTI per year and it takes 6 weeks to fully recover. Planning an Anaesthetic is therefore a logistical challenge

Question 3

How should parents be counseled with regard to performing an Anaesthetic in a child with URTI

Answer 3

The risk of complications is higher but the complications are manageable and the serious and long term risks to the child are minimal.

Question 4

What demographic of patients are affected by bronchopneumonia versus lobar pneumonia

Answer 4

Bronchopneumonia - Very young, Old, Immunecompromised, COPD, Bronchiectasis, Mucociliary escalator compromise

Lobar - Young and fit

Question 5

What organisms commonly associated with bronchopneumonia

Answer 5

Strep/Staph/H.influenzae/coliforms

Question 6

What organisms are commonly associated with lobar pneumonia

Answer 6

Strep pneumoniae

In elderly/diabetic/alcoholics - Klebsiella

Question 7

How does the presentation of typical and atypical pneumonia differ

Answer 7

Respiratory symptoms in atypical pneumonia are usually preceded by a systemic prodrome. Atypical pneumonia does not respond as expected to conventional antibiotics.

Question 8

List common causative organisms for typical and atypical pneumonia

Answer 8

Typical
Streptococcus pneumoniae
Staphylococcus pneumoniae
Haemophilus influenzae
Klebsiella pneumoniae (Extremes of age and immunocompromised)

Atypical (Multisystem illness with systemic prodrome)
Legionella pneumophilia
Mycoplasma pneumoniae
Chlamydia pneumoniae
Chlamydia psittaci

Question 9

What should be done if a patient is diagnosed with pneumonia just prior to elective surgery

Answer 9

Postpone for 6-8 weeks (even in cancer cases)

Question 10

What are the anaesthetic considerations in taking emergency patients with pneumonia to theatre?

Answer 10

1. ? RA only
2. ? Epidural (Post op deep breath and cough vs risk of sepsis)
3. If GA required:
   - LMA (less stimulating to airways) vs ETT (better control ventilation and access for suctioning)

A - line: Serial ABG + CVS stability
CV - line: Fluid balance

Question 11

What intra-operative issues will require considering if a GA is done in a patient with pneumonia

Answer 11

High PEEP
High FiO2
Limit peak airway pressures if possible
Intermittent ETT suction
Rx Temp and hydration

Question 12

What post-operative issues are important after GA for a patient with LRTI

Answer 12

HDU/ICU bed
Optimal analgaesia - coughing and clearing of secretions
- RA - epidurals are risky in systemic sepsis
- Opioids depress respiratory drive and reduce coughing
Physiotherapy
Humidified oxygen

Question 13

What are the % incidences for the following causes of pneumonia?

Streptococcus pneumoniae

Viruses

Haemophilus influenzae

Legionella pneumophila

Staphylococcus aureus

Answer 13

Streptococcus pneumoniae
30-40 %

Viruses
10-15 %

Haemophilus influenzae
5-10 %

Legionella pneumophila
0.5-3.5 %

Staphylococcus aureus
1-2 %