Risk of post-operative pulmonary complications

الموضوع في 'كتب طبية' بواسطة ashdom, بتاريخ ‏أكتوبر 23, 2014.

  1. ashdom

    ashdom Active Member

    إنضم إلينا في:
    ‏ديسمبر 8, 2008
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    362
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    146
    نقاط الجوائز:
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    الجنس:
    ذكر
    الوظيفة:
    Consultant Anesthesiologist


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    Patients at risk Respiratory complications of anaesthesia:

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    1-diseas

    COPD

    Congestive heart failure


    2-Obese


    3-surgery type


    Aortic aneurysm repair

    Thoracic surgery

    Abdominal surgery

    Upper abdominal surgery

    Neurosurgery

    Head and neck surgery

    Emergency surgery

    Vascular surgery


    Major intracranial surgery & Thoracic surgery > Upper abdominal surgery


    Upper abdominal surgery > Lower abdominal surgery


    Lower abdominal surgery > Limb surgery



    4-Prolonged bed rest


    5-Long surgery > 180 minutes



    6-Elderly > 65 yearw


    7-Smoking


    8-ASA class ≥2


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    Recommendations of the American College of Physicians to reduce perioperative pulmonary complications in patients undergoing non-cardiothoracic surgery.

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    Recommendation 1:

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    • All patients undergoing non-cardiothoracic surgery should be evaluated for the presence of the following significant risk factors for postoperative pulmonary complications in order to receive pre- and postoperative interventions to reduce pulmonary risk:

    chronic obstructive pulmonary disease, age older than 60 years, American Society of Anesthesiologists class of II or greater, functionally dependent, and congestive heart failure.


    • The following are not significant risk factors for postoperative pulmonary complications: obesity and mild or moderate asthma.


    Recommendation 2:

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    • Patients undergoing the following procedures are at higher risk for postoperative pulmonary complications and should be evaluated for other concomitant risk factors and receive pre- and postoperative interventions to reduce pulmonary complications:

    prolonged surgery (>3 hours), abdominal surgery, thoracic surgery, neurosurgery, head and neck surgery, vascular surgery, aortic aneurysm repair, emergency surgery, and general anesthesia.


    Recommendation 3:

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    • A low serum albumin level (<35 g/L) is a powerful marker of increased risk for postoperative pulmonary complications and should be measured in all patients who are clinically suspected of having hypoalbuminemia; measurement should be considered in patients with one or more risk factors for perioperative pulmonary complications.


    Recommendation 4:

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    • All patients who after preoperative evaluation are found to be at higher risk for postoperative pulmonary complications should receive the following postoperative procedures in order to reduce postoperative pulmonary complications:

    deep breathing exercises or incentive spirometry and the selective use of a nasogastric tube (as needed for postoperative nausea or vomiting, inability to tolerate oral intake, or symptomatic abdominal distention).


    Recommendation 5:

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    • Preoperative spirometry and chest radiography should not be used routinely for predicting risk for postoperative pulmonary complications.

    • Preoperative pulmonary function testing or chest radiography may be appropriate in patients with a previous diagnosis of chronic obstructive pulmonary disease or asthma.


    Recommendation 6:

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    • The following procedures should not be used solely for reducing postoperative pulmonary complication risk:

    right heart catheterization and total parenteral nutrition or total enteral nutrition (for patients who are malnourished or have low serum albumin levels).
     

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