copd & bronchictasis & anaesthesia consideration in patients posted for sugery

1. COPD/ASTHMA/BRONCHIECTASIS-
PERIOPERATIVE CONSIDERATIONS

27.  ECG:RVH,RAD
RT atrial enlargement
increase pul. artery pressure-RVF
 ABG:hypoxia
Compensated type 2 RF(normal pH
hypercarbia ,inc. HCO3)

43. INTUBATION
 Attenuation of intubation response:
 i/v lignocaine:1-1.5 mg/kg 90 sec prior to laryngoscopy
 Fentanyl and esmolol bolus can also be used
 Adequate plane of anaesthseia
 Scholine :1-2 mg/kg
 Rocuronium:0.6-1.2 mg/kg
 Vecuronium:0.08-0.1 mg/kg
 LMA v/s ETT-avoid tracheal stimulation
 2nd gen LMA also allow suctioning

48. REVERSAL
 Neostigmine-may provoke bronchospasm
 Atropine/glycopyrrolate should be give prior to
neostigmine
 Tracheal toileting
 Extubation-awake mostly (however deep extubation can
reduce risk of bronchospasm)

55. ASTHMA

60.  INVESTIGATIONS
 CXR-N/ hyperinflated
 ECG-RVF during asthmatic attack
 PFT: reversible obstructive ds, increase in FEV1>15%
from baseline by b agonist inhaler
 No breath test:N<25ppm,asthma>50ppm
 ABG:type1>type 2 RF

75. BRONCHIECTASIS

91. NOTE
 Optimal ventillatory pattern:
-Small TV(6-7ML/KG),inc. RR, dec PEEP
-These all help prevent excess rise in alveolar pressure &
thus decrease blood diversion from alveoli, which help in
maintaining PaCO2(35-45mmHg)
 Drugs causing histamine release are preferably
avoided(can cause bronchospasm).
 However ketamine, having brochodilator properties, min.
HPV & thus min. V/Q mismatch.

96. QUESTIONS ON COPD:
 How would you assess 70 yr old man with COPD who present for laparotomy?
 What Inx may be useful?
 What mode of ventillation would you use intraoperatively?
 What role should regional anaesthesia play in pt. with severe COPD with active
infection for postop. analgesia?
 What can be done postop to help reduce problems associated with COPD?
QUESTIONS ON BA:
 What causes asthma?
 Classify pharmacological strategies used in mgt. of asthma?
 Should positive end expiratory pressure be used in pt. with asthma for
laparotomy?
 Should steroid supplimentation be given to asthmatic on long term inhaled
fluticasone undergoing major sx?
 What is your approach to asthma in pregnancy?