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Post op resp failure (Definition (Inadequate exchange of 02 and C02…
Post op resp failure
Definition
Inadequate exchange of 02 and C02 present after a surgical procedure and as a result of the changes induced by anaesthesia and surgery
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DDx
Upper airway obstruction (laryngospasm, FB, anaphylaxis)
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Lung disease (pneumothorax, PE, pneumonia, aspiration, atelectasis, ARDS)
Chest wall or diaphragmatic dysfunction (NM dysfunction, residual NMB, high epidural)
Neurological dysfunction (delerium, anxiety)
Assessment
History
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Surgical factors (op site, decreased FRC, pain, immobility, type of procedure)
Anaesthetic factors (intubation hx, aspiration, ventilator mgmt, fluid/blood tx -PO, timing and dosing of drugs, drug interactions infection control)
Exam
Airway (swelling, FB - throat pack, obstruction - noisy breathing)
Resp (bronchospasm, WOB, muscle power, RR, temp)
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Investigation
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Pulse ox, nerve stimulator, ABG, CXR, cultures, ECG
Prevention
Ventilatory
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Avoid atelectotrauma (PEEP, recruitment)
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Non ventilatory
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Adequate post op analgesia, without excessive sedation
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Avoid transfusion (alleviate preoperative anaemia, blood saving strategies)
Decrease risk of pulmonary infection (antibiotic prophylaxis, tooth brushing, avoid nasal ETT)
Surgical technique (thorascopic or laparoscopic approach, reduce surgical duration, defer sx if required)
Management
Non pharmacological
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Physiotherapy, incentive spirometry
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Suction, NIV, +/- reintubation and ventilation, PEEP
Pharmacological
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Address causes (e.g. diuretics, antibiotics, NMB reversal)