Peri-op  TOC  

PERIOPERATIVE POCKET MANUAL 2005  (Contents)  - 3rd Edition
Maracus Magallanes, MD 2005

5. PULMONARY CONCERNS

CHRONIC OBSTRUCTIVE LUNG DISEASE

*COPD/asthma
is a major risk factor for the development of postoperative pulmonary complications. As a rule, the risk of pulmonary complications is directly related to the severity of the lung disease AND the proximity of the surgical site to the thorax and diaphragm. Pulmonary function testing has very limited utility in the inpatient pre-operative setting.

MANAGEMENT:

  1. Bronchodilator therapy with albuterol HHN; add atrovent HHN if emphysematous type lung disease.
  2. Oral theophylline therapy should be continued if patient uses this chronically. If the patient is NPO for an extended interval and is dependent on theophylline therapy, then IV aminophylline can be administered until patient is able to resume the PO medication. (For many patients, however, theophylline therapy is of question-able value and can simply be withheld while NPO.)
  3. Antibiotics should only be administered if bronchitis or pneumonia is suspected; no use prophylactically for lung disease.

         PERIOPERATIVE POCKET MANUAL 2005  (Contents)

RESTRICTIVE LUNG DISEASE    
*The risk of pulmonary complications in patients with restrictive lung disease is unknown, although it appears to be much less than that associated with obstructive disease.

MANAGEMENT:

         PERIOPERATIVE POCKET MANUAL 2005  (Contents)

POSTOPERATIVE PROPHYLACTIC MEASURES IN PATIENTS WITH LUNG DISEASE:

  1. Incentive spirometry
  2. Sit patient up and mobilize out of bed ASAP
  3. Pain control
  4. Aggressive suctioning if secretions are increased
  5. DVT prophylaxis

         PERIOPERATIVE POCKET MANUAL 2005  (Contents)

POSTOPERATIVE PULMONARY EMBOLISM

*Mortality in general for acute PE is up to 30% but can be reduced to 10% or less with proper management.

PRESENTATION:
Acute dyspnea, tachypnea and pleuritic pain are the most common signs/symptoms. Other findings may include tachycardia/tachyarrhythmia, cough, hemoptysis, fever, or rales. Massive PE may cause shock or sudden death.

DIAGNOSIS:

Management:
Acute anticoagulation (heparin drip or enoxaparin, later coumadin)-*Must address bleeding risk with surgeon before initiating anticoagulation. IVC filter recommended if patient with PE cannot be anticoagulated.

         PERIOPERATIVE POCKET MANUAL 2005  (Contents)