4 Pre-op: Pulmonary Flashcards
(20 cards)
In a patient with known asthma, the anesthesiologist should enquire about (9)
- Dispneia
- Pressao toracica
- Tosse (especialmente noturna),
- Terapia (especialmente corticoides)
- Hospitalizacoes previas
- Visitas a emergencia
- Internacoes em UTI
- Necessidade de IOT
- IVAS recentes
It is helpful to ask patients to compare their current asthma symptoms to their “normal” or “best” status based on symptoms, exercise tolerance, and medication requirements.
Como classificar a asma?
- Intermitente
- leve persistente
- Moderada persistente
- Grave persistente
Baseada em:
- Sintomas
- Despertares noturnos
- Uso de borncodilatadores
- Prejuizo as atividades diarias
Qual a definicao de bronquite cronica?
Chronic bronchitis is defined as a chronic productive cough for three months in each of two successive years in a patient in whom other causes of chronic cough (e.g., bronchiectasis) have been excluded.
Qual a definicao de Enfisema
Emphysema refers to pathologic structural changes in the lung that can occur with COPD, including enlargement of airspaces distal to the terminal bronchioles, as well as destruction of these airspace walls.
A definicao de exacerbacao de DPOC é”
“an acute worsening of respiratory symptoms that result in additional therapy” (http://www.goldcopd.org).*
There is no clearly established threshold of COPD severity indicative of highly prohibitive perioperative risk. In general, PFTs are not useful for estimating perioperative risk in patients with COPD, except possibly for:
individuals undergoing lung resection surgery
In general, preoperative PFTs are indicated when: (2)
- there is uncertainty as to whether the patient’s lung function is optimized, or
- uncertainty as to the underlying basis for unexplained dyspnea
Em que populações o Score STOP-BANG deve ser utilizado?
Alto risco para SAOS:
- obesidade
- Comorbidades (HAS, IC, DM)
- Caracteristica de dificil intubacao
Riscos associados a pacientes com SAOS
- Ventilacao e intubacao difíceis
- Mais sensíveis a depressao respiratória por opioides
- Risco de complicacoes respiratorias e cardiovasculares
- Internacao prolongada
There is debate as to how much of this elevated risk is caused directly by OSA, versus its associated comorbidities (e.g., IHD, HF, diabetes mellitus, obesity).
Quais os criterios de STOP-BANG
- < 2 : baixo risco
- > 5: alto risco
- 3 ou 4: intermediario. Solicitar bicarbonato > 28mmol/L
Tobacco exposure, either directly or through “second-hand” smoke, increases the risk of many perioperative complications.
- V ou F?
- Verdadeiro
The main recommended pharmacologic interventions for smoking cessation in the peri-operative setting are ___1___ and ___2___.
- nicotine replacement therapy (i.e., nicotine patches, gum, or lozenges)
- varenicline (should be started at least one week before an attempt at quitting).
Beneficios precoces da interrupcao de tabagismo: (4)
- Queda dos niveis de monóxido de carbono
- Queda de cianeto
- Reducao de nicotina
- Clearance de substancias toxicas que impedem a cicatrização
Em que situacoes o uso de maconha nao deve ser interrompido?
- Cirurgia em < 24h
Quando suspender cirurgia em caso de infeccao respiratoria? (2)
- Sintomas graves (febre alta)
- comorbidades (asma importante, doenca cardiaca, imunossupressão, por ex)
Postergar cirurgia por 4 semanas apos a resolucao da infeccao.
In the case of children with current or recent upper respiratory tract infections (see also Chapter 72), risk indices such as the ___1___, can help stratify expected risk for perioperative respiratory events and thereby better inform clinical decision- making.
- COLDS score
https://scihub.se/https://doi.org/10.1111/pan.13491
Dos fatores de risco relacionados ao paciente para complicacoes pulmonares, quais estao notadamente AUSENTES? (3)
- Asma
- Gasometria arterial
- Provas de funcao pulmonar.
When high-risk patients are identified before surgery, the anesthesiologist has several available options to help decrease the perioperative pulmonary risk. These approaches include
- Interrupccao de tabagismo
- Tratar exacerbacao recente de Asma ou DPOC
- Tratar IVAI
Como é o escore ARISCAT?
Potential Laboratory Test Risk Factor para complicacoes pulmonares (3)
- Albumin concentration < 3.5 g/L
- Chest radiograph abnormalities
- BUN concentration >7.5 mmol/L (>21 mg/dL)
