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Evaluation and perioperative management of patients with respiratory diseases

Thesis

Last updated: 06 Feb 2023

Subjects

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Tags

Anesthesia

Advisors

Ebrahim, Fawzeya A. , Aumran, Amina H. , El-Refaei, Nesrin A.

Authors

Muhammad, Mussttafa Abdel-Razeq

Accessioned

2017-03-30 06:21:40

Available

2017-03-30 06:21:40

type

M.Sc. Thesis

Abstract

Respiratory diseases are one of the most frequently encountered problems in anesthetic practice, which may add to the risk of the operation. This includes some of the commonest respiratory diseases like: COPD and bronchial asthma.COPD is a title which is used mainly to refer to patients with chronic bronchitis and emphysema characterised by the development of respiratory obstruction.Bronchial asthma is chronic inflammatory disorder of the airways leading to recurrent episodes of wheezing, breathlessness, chest tightness and coughing in response to variable stimuli. These episodes are usually associated with variable widspread airways obstruction, that is often reversible.Preoperative assessment of the patient's condition was discussed to help in reducing the expected complications and their management. A good assessment can be achieved by carefull history, examination and investigation including pulmonary function tests in detail.Proper preoperative preparation is mandatory intending to improve the respiratory condition through, eradication of infection, cessation of smoking, treatment of bronchospasm and chest physiotherapy.Premedication using narcotics and sedatives should be avoided in patients with preoperative hypercapnea (PaCO2 > 50 mmHg) or with hypoxia (PaO2 < 60 mmHg). Regional anesthesia is much preferable than general anesthesia as it avoids trachea! intubation and general aneathetic agents that may initiate bronchospasm.Regarding general anesthesia, different induction agents are discussed as methohexitone, etomidate, profol and ketamine. Thiopentone could be used with caution as it causes bronchospasm. Maintenance inhalational anesthetic agents discussed including halothane, enflurance, isoflurane, and the most recent, desflurane and sevoflorane. The bronchodilator effects of halothane must be weighed against its cardiovascular depressant effect. The newer inhalational agents such as enflurane and isoflurane produce bronchodiatation but without the risk of cardiovascular depression, so, they are better alternative.The use of elective postoperative artificial ventilation may be required for supporting patients with pre-existing COPD under certain circumstances. Postoperative pulmonary complications include hypoxaernia, hypoventilation, atelectasis and pneumonia all of which can be minimized by good preoperative preparation, proper management intraoperatively and careful attendance to the patients in the early postoperative period.

Issued

1 Jan 2004

Details

Type

Thesis

Created At

28 Jan 2023