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PATIENT WITH
RESPIRATORY DRUGS
Sabella Trinolaurig
Rina Desdwi Utami
Christian Ade
INTRODUCTION
Safe and efficient surgical and anesthesia practice
requires an optimized patient.
INTRODUCTION
Pulmonary disease
INTRODUCTION
The co-morbidities and the nature of the procedure are
considered when managing medications preoperatively.
Pulmonary Complication :
Major
Respiratory failure
Mechanical Ventilation &/
intubation >48 h
Pneumonia
Minor
Purulent tracheobronchitis
Atelectasis
Bronchospasm
Sweizer BJ. Basic Standarts For Preanesthesia Care : Preoperative Evaluation and
Thomas J. Gal. Perioperative Approach to Patients with Respiratory Disease. International Anesthesia
How to reduce ?
Achieve adequate preoperative
evaluation
complication, perioperative
morbidity & hospital stay
Recomendation : patients with previous Respiratory Disease evaluated by
a Pulmologist.
Surgeryrelated
aspects
Anesthesia
-related
aspects
Patientrelated
aspects
3. Blood Test
(urea >21
mg/dl, albumin
< 3,5 mg/dl,
creatinin > 1,5
g/dl)
4. Chest X-ray
(patient with
prior
cardiopulmonar
y disease, >40
years,
medium/surger
y)
5. Pulmonary
function
6. Arterial
blood
gases :
.Patient
with
chronic
lung
disease
.Moderatesevere
airway
Electrocardiogram
obstruction
Echocardiography
Preoperative Assessment
1. Medical
History
2. Physical
Examination
Initial evaluation is
clinical
Complementary
examination should
be requested based
on this assessment
Sweizer BJ. Basic Standarts For Preanesthesia Care : Preoperative Evaluation and
Thomas J. Gal. Perioperative Approach to Patients with Respiratory Disease. International Anesthesia
L.H. Degani-Costa et al. Preoperative Evaluation of The Patient with Pulmonary Disease. Rev Bras
Asthmatic patient
Poor control ( > 20%
variability in PEFR (Peak
Expiratory Flow Rate)
Review by A Physician
1 week course of oral
prednisolone (20-40
mg/day)
Intraoperative
Anesthesia
Adequacy of
alveolar
ventilation,
perfusion
Respiratory
impairment
Blood
oxygenation
L.H. Degani-Costa et al. Preoperative Evaluation of The Patient with Pulmonary Disease. Rev Bras
Postoperative Care
Adequate analgesia is vital
Avoid analgesics that depress the respiratory system
Mild pain use simple analgesics (dipyrone, paracetamol) &
hormonal/ non-hormonal anti-inflammatory drugs
Postoperative Care
Oxygen adnistered : minor surgery until the patient fully awake
major surgery 2-4 L/min for 72 hours
Postoperative Care
Regular nebuliser therapy with additional nebulised
bronchodilators as needed.
L.H. Degani-Costa et al. Preoperative Evaluation of The Patient with Pulmonary Disease. Rev Bras
KETAMINE
(C1-581, 2-O-chloro-phenyl-2-methylaminocyclohexanone)
Pencyclidine (C1-395)
1958
Ketamine (C1-581)
1960s
(1 of 200 pencyclidine derivates)
Aniruda Pai and Mark Heining. Continuing Education in Anesthesia, Critical Care and Pain : Ketamine. British Journa
Mechanism of Action
Non-competitive antagonism at the N-methyl-D-aspartate
Ketamine has
minimal effects
on central
respiratory drive
As effective as
halotane in
preventing
bronchospasm
TERIMA
KASIH