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Respiratory (Asthma (Anaesthesia
HPV ablated by volatiles
Can worsen…
Respiratory
Asthma
Pathology
- Inc airway resistance
- Inc WOB
- Inc expiratory time
- Inc TLC, FRC and FV due to gas trapping
Spirometry
- FEV1/FVC <70%
- FVC may be reduced after acute attack
Hypoxaemia due to VQ inequality
- Reduced alveolar ventilation --> shunting
Anaesthesia
- HPV ablated by volatiles
- Can worsen hypoxaemia by inc shunt
Ventilation: reduce dynamic hyperinflation
- low Vmin
- Low Vt
- High insp flow rates
- long I;E ratio
- No PEEP
- Permissive hypercapnia
- Pplat <25cmH2O (measure >0.5s end-exp pause)
Respiratory infection
-
Pneumonia
- Alveolar oedema
- Increased WOB
- Hypoxia and hypercarbia
Aspiration
Neurological
- Stroke
- Low GCS
- Parkinsons
Gastro-oesophageal
- TOF
- Sphincter tone
- Pregnancy
- Obesity
Cancellation:
- productive cough
- fever
- generally unwell
- auscultation signs
- concurrent chest disease
- raised WCC
Obstructive sleep apnoea
Risk Stratification
-
STOPBANG
Snore
Tired in daytime
Observed apnoea
Pressure (BP)
BMI >35m2
Age >50
Neck Circumference >40cm
Male
Pathology
CNS
- Inc risk stroke
- Psychosocial
- Depression
- Cerebral auto regulatory failure
Endocrine
- Glucose intolerance
- Dyslipidaemia
Increased ACTH and cortisol
- Associated testicular and ovarian dysfn
- PCOS
- Hypothyroidism
CVS
- Hypertension
- Arrhythmia
- Biventricular dysfunction
- Pulmonary hypertension
- CCF
- Myocardial infarction (independent rf)
-
Anaesthetic considerations
- Susceptible to sedatives and OIHV
Restrictive lung disease
Causes
Parenchymal
Pulmonary Fibrosis
Idiopathic:
Secondary:
- pneumoconiosis
- Rheumatoid arthritis
Mechanical
Chest wall deformities
- Kyphoscoliosis
- Rib fractures
Neuromuscular
- GBS
- Muscular dystrophies
- Myasthenia graves
- Ageing
Pathology
- Decreased chest all compliance
- Relatively fixed Vt
- Compensate with inc RR
- Decreased TLC, FRC, RV
- Atelectasis
- VQ mismatch: dead space and shunt increased
- Decreased DLCO
Spirometry
- Increased FEV1/FVC ratio (>80%)
- Decreased FEV1 and FVC but FVC by more
- Decreased DLCO
-
Pulmonary embolus
-
Acute hypoxaemia
Cardiovascular collapse (large, proximal)
Chronic: RV failure and pulmonary HTN
ARDS
- Reduced PaO2/FiO2 ratio with PEEP >=5
- Mild = 201-300mmHg
- Moderate 101-200mmHg
- Severe =< 100mmHg
- Bilateral opacities not explained by other
- Onset within 1 week of insult or new/worsening symptoms
- Respiratory failure not explained by CCF or overload
Pathology
- Early = exudative
- Late = fibroproliferative
Hypoxaemia
Pulmonary HTN
- HPV, collapse, hypercarbia
-
Risk Stratification for post-op respiratory complications:
Age 60-69 x2 of younger
Age 70-79 x3 of younger
COPD = most common RF but not linked to spiro
Cigarettes: small inc
CCF
ASA >=2
Functional dependency (total or partial)
Altered GCS
Surgery: intra-cavity, >3hrs, vascular, AAA repair, head&neck, emergency
GA: association only
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