B is for Breathing Irene Bouras Anaesthetic SpR UCLH.
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Transcript of B is for Breathing Irene Bouras Anaesthetic SpR UCLH.
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B is for BreathingIrene Bouras
Anaesthetic SpR UCLH
the centre forAnaesthesia UCL
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Pre-Operative Considerations
• Assessment of respiratory function– History– Examination– Investigations
• Functional assessment is the most important
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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?
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Optimising Respiratory Function
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Intra-operative
• Pre-operative monitoring & IV access• ?Pre-oxygenation• Induction of anaesthesia
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Intra-operative
• Pre-operative monitoring & IV access• ?Pre-oxygenation• Induction of anaesthesia
ApnoeaAirway obstruction
Take over ventilation & secure airway
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Intra-operative Ventilation
Spontaneous• Don’t need to stop & start
breathing• RR good guide to degree of
pain
BUT
• Prone to hypoventilation
IPPV• Prevent atelectasis• Can control ETCO2
BUT
• Can cause barotrauma & volutrauma
• Higher risk of awareness
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Monitoring Ventilation
Patient Parameters
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Monitoring Ventilation
Ventilator Parameters
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Monitoring
Oxygen Saturations• Monitors oxygenation
not ventilation
End-Tidal CO2
• Measures adequacy of ventilation
• Confirms circuit is intact & that patient has CO
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•Tidal Volume 8-10mls/kg
•Frequency 10-12/min•FiO2
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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
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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