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 – Investigations Functional assessment is the most important Will they be difficult to ventilate? What are your options?

Optimising Respiratory Function

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

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

Intra-operative Ventilation Spontaneous Dont need to stop & start breathing RR good guide to degree of pain BUT Prone to hypoventilation IPPV Prevent atelectasis Can control ETCO 2 BUT Can cause barotrauma & volutrauma Higher risk of awareness

Monitoring Ventilation Patient Parameters

Monitoring Ventilation Ventilator Parameters

Monitoring Oxygen Saturations Monitors oxygenation not ventilation End-Tidal CO 2 Measures adequacy of ventilation Confirms circuit is intact & that patient has CO

Tidal Volume 8-10mls/kg Frequency 10-12/min FiO 2

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

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