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Airway Disease
Areas covered
Pathophysiology
Medical Management
Assessment of Bronchial Asthma
Preparation
Anaesthesia
Areas covered..
Management of Acute Severe Asthma in OT
COPD
Principles of Mx
Bronchial Asthma
A chronic inflammatory condition of lungs.
Common -10%
Symptoms
Cough
Wheeze
Chest tightness
SOB
Characteristic features
Airflow limitation
Airway hyper responsiveness
Inflammation
Causes
Atopy- Enviornmental
Pollen
Dust
Pollution
Viral infections
Causes
Cold air
Emotions
Occupational
Drugs - NSAIDS
Beta blockers
Pathophysiology
Inflammation
(Steroids)
Bronchoconstriction (beta2 agonists)
Cholinergic effect causing
Bronchoconstriction
(Ipratropium=atropine)
Pathophysiology
Histamine H1=Bronchoconstriction
Management of BA (WHO
guidelines)
Lifestyle modification
Stepwise Rx with,
Inhaled beta agonists sos
Regular inhaled steroids
Plus regular beta agonists
Salmeterol, terbutaline
Steroids- Beclamethasone etc
Mast cell stabilisers- Sodium
chromoglycate
Treatment contd.
Anticholinergics- Ipratropium
Theophylline preparations
Oral steroids
Leucotrine receptor antagonists
Assessment of BA Pts
Duration
Symptoms
Precipitants
Rx & Compliance
Assessment of BA patients..
Effect on daily life
Acute attacks- Nebulisations
Hospitalisation
ICU admissions, ventilation
Previous anaesthetics
Investigations
CXRAY if indicated
Lung function tests-FEV1/ FVC
<60
OT
Optimise medical Mx if not
under control
100mg
Choice of anaesthesia- GA vs
Regional
Need to have minimal lung signs for
both
Spinal will avoid multiple drugs/
stimulation of airway
Epidural
Avoid high blocks
GA
How the anaesthetic is given is more important than
what the agent is
Safe drugs
Propofol
Ketamine(add atropine)
Etomidate
Midazolam
Possible precipitants
?TPS
? morphine
? Atracurium
Possible precipitants..
Protamine
Neostigmine
Diclofenac/ aspirin
Antibiotics
During anaesthesia
Try to avoid intubation- Face
mask/ LMA
Maintain adequate depth
Avoid stimulation under light
anaesthesia (ETT/surgery)
Secretions may precipitate
Intra op management..
Ventilate withSlow RR/moderate Vt; I :E> 1:2
Possible causes..
Anaphylaxis/ other hypersensitivity
reaction
Aspiration
Pneumothorax
Endobronchial ETT/ circuit occlusion
Management
Increase oxygen flow while
maintaining depth
Increase volatile agent (halothane)
Remove precipitant
Management contd.
Nebulise with -5mg salbutamol
0.5mg Ipratropium
(need circuit adaptor/oxygen driven
neb)
Steroids- 200 mg Hydrocortisone IV
Drug Rx
Aminophylline IV- 5mg/Kg bolus
in dextrose/20 min
(250 mg in a vial)
Follow up infusion at
0.5mg/Kg per hour
Salbutamol IV infusion
COPD
Chronic bronchitis &
emphysema
Abnormal lungs
Smoking/ other factors
COPD..
Infections
Hyperinflated lungs
Cor-pulmonale
Features of COPD
Pink puffers=compensated
Blue bloaters=decompensated
Airway obstruction is not completely
reversible
Rx- Beta 2 agonists/ steroids/
diuretics
Assessment
Functional capacity
How many pillows
CXRAY
Arterial blood gases
LFT
Anaesthesia
High risk
Avoid elective surgery if not well
controlled
Stop smoking
Rx Infection
Steam, Chest physio
Exam Questions
Anaesthetic management of BA patient for
elective surgery
Acute asthmatic attack under GA
Short notes on salbutamol/ aminophylline
Thank you!