Anesthesia Student Survival Guide.pdf - Index of

90 ● AnesthesiA student survivAl Guide
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The type of surgery
Use of pancuronium
1
Clinical evaluation should encompass a thorough history (i.e., questioning
about shortness of breath, wheezing, chest pain, bronchitis, asthma, emphysema,
recent fever/chills, history of pneumonia or lung surgery, use of steroids)
and a physical exam (i.e., auscultation for decreased breath sounds, wheezes,
rhonchi, prolonged expiratory phase). Once all of the information is gathered,
risk-reduction strategies (Table 8.2) can be applied to optimize patient care.
Hepatic and Gastrointestinal Disease
Hepatic disease can contribute to end-organ dysfunction (endocrine system,
pulmonary edema, pulmonary hypertension, renal failure, and cardiomyopathy)
and increase the risk during certain surgeries. Hepatic disease can also
cause abnormal coagulation and altered drug pharmacokinetics.
Table 8.2 Risk reduction strategies for pulmonary complications.
Preoperative
• Smoking cessation (for at least 8 weeks)
• Treat airflow obstruction (patients with CoPD or asthma)
• Give antibiotics / postpone surgery in presence of respiratory infection
• educate patients about lung-expansion maneuvers
Intraoperative
• limit surgical duration