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B is for Breathing

B is for Breathing. Irene Bouras Anaesthetic SpR UCLH. Pre-Operative Considerations. Assessment of respiratory function History Examination Investigations Functional assessment is the most important. Pre-Operative Considerations. Assessment of respiratory function History Examination

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B is for Breathing

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  1. B is for Breathing Irene Bouras Anaesthetic SpR UCLH

  2. Pre-Operative Considerations • Assessment of respiratory function • History • Examination • Investigations • Functional assessment is the most important

  3. Pre-Operative Considerations • Assessment of respiratory function • History • Examination • Investigations • Functional assessment is the most important • Will they be difficult to ventilate? • What are your options?

  4. Optimising Respiratory Function

  5. Intra-operative • Pre-operative monitoring & IV access • ?Pre-oxygenation • Induction of anaesthesia

  6. Intra-operative • Pre-operative monitoring & IV access • ?Pre-oxygenation • Induction of anaesthesia Apnoea Airway obstruction Take over ventilation & secure airway

  7. Intra-operative Ventilation Spontaneous IPPV Prevent atelectasis Can control ETCO2 BUT Can cause barotrauma & volutrauma Higher risk of awareness • Don’t need to stop & start breathing • RR good guide to degree of pain BUT • Prone to hypoventilation

  8. Monitoring Ventilation Patient Parameters

  9. Monitoring Ventilation Ventilator Parameters

  10. Monitoring Oxygen Saturations • Monitors oxygenation not ventilation End-Tidal CO2 • Measures adequacy of ventilation • Confirms circuit is intact & that patient has CO

  11. Frequency 10-12/min • FiO2 Tidal Volume 8-10mls/kg

  12. Post- Operative • Respiratory compromise may be caused by many factors • Patient factors: pre-existing lung disease • Anaesthetic factors: high epidural, high dose opiates • Surgical factors: diaphragmatic splinting • May need to keep some patients intubated on ICU post-op

  13. Summary • A good pre-operative assessment is essential • Get respiratory function as good as possible pre-op • If you’re worried about ventilation intra-operatively the monitors should give you an idea where the problem lies

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