Surgery Types/Effects
name 3 physiological risk factors for surgery
More closing volume Decreased elastic recoil Weaker resp muscles Lower chest wall compliance Lower response to hypoxemia and hypercapnia More oxygen demand Lower total lung compliance and FRC
Following general anaesthetic, which is more common postoperative cardiac or pulmonary complications?
Pulmonary
What % of vital capacity does a surgical patient lose on average after surgery?
50%
How many patients suffer from anesthesia induced lung collapse?
90%
List 3 common symptoms that may occur in patients after a general anaesthetic to the upper abdomen
Drowsiness, nausea, immobile, pain, partial lung collapse, diaphram dysfunction
What type of surgery has the lowest number of PPCs?
Orthopedic
The risk of PPC increases with the length of time spent under general anaesthetic(T/F)
TRUE
How long on average is lung function altered after srugery?
48 hours
Name at least 3 ways to help mitigate the effects of atelectasis post-op
early mobolisation, Positive airway pressure, analgesia, secretion treatments, good positioning, deep breathing exercises/cough
What lobes/areas of the lung is ventilation the best and perfusion the best? In adults
Ventilation: higher lobes
What is the most common complication after thoracic surgery?
Pneumonia- 10%
List at least 4 factors which increase the risk of PPC
Age (60<), surgery type, comorbidities (COPD, congestive HF, Chronic liver disease), smoking, pre-operative anaemia, low tidal volume, neuromuscular blocking drugs, dry or cold oxygen
Give 3 reasons for a V/Q mismatch
Lowered FiO2, sputum, diffusion abnormality, ventilation without perfusion or perfusion without ventilation
What are the 3 best positions for V/Q matching post-op
side lying on healthy side, sitting or standing upright, prone
Name 4 of the 5 preventative measures for surgery Bonus point: how long prior to surgery does a patient need to have stopped smoking for, for it to make a significant difference? (Decrease the chance of PPC)
stop smoking, lose weight, improve fitness, improve nutrition, complete prehabilitation 4 weeks or more
Protective lung ventilation enhances gas exchange and reduces the risk of PPC. Is this strategy administered before, during or after surgery?
During. When compared with alveolar recruitment maneuver (ARM), PLV with positive end expiratory pressure (PEEP) is more effective at reducing PPC.
List five types of montioring which could be used to assess lung function after general anaesthetic
CT scan (can identify consolidation and atelectasis), ABGs, auscultation, BP, HR, RR and temperature
What two issues most commonly affect lung function after surgery(because of the anesthesia)?
atelectasis and mucous/sputum build up
How many post-op complications are a PPC?
40%
how many surgeries result in a PPC?
23%
What is the surgery with the highest risk of PPCs
abdominal aortic aneureysm repair
Explain the mechanism behind why a patient may experience atelectasis after a general anaesthetic
Reduced functional residual capacity, relaxation of diaphram muscles, decrease in function of mucocillary escalator, reduced clearance of sputum and increased risk of atelectasis and infection
Name three issues that could constitute a PPC
infection, atelectasis, sputum retention, pneumothorax, Pleural effusion
List 5 symptons you may expect to see in a patient suffering from PPC
SOB, pyrexia, increased HR, increased RR, shallow breathing,
What percentage of patients will die within 30days of developing PCC
14 - 30% or one in five