B is for Breathing

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B is for Breathing

• Irene Bouras
• Anaesthetic SpR UCLH

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Pre-Operative Considerations

• Assessment of respiratory function
• History
• Examination
• Investigations
• Functional assessment is the most important

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Pre-Operative Considerations

• Assessment of respiratory function
• History
• Examination
• Investigations
• Functional assessment is the most important
• Will they be difficult to ventilate?
• What are your options?

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Optimising Respiratory Function
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Intra-operative

• Pre-operative monitoring IV access
• ?Pre-oxygenation
• Induction of anaesthesia

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Intra-operative

• Pre-operative monitoring IV access
• ?Pre-oxygenation
• Induction of anaesthesia
• Apnoea
• Airway obstruction
• Take over ventilation secure airway

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Intra-operative Ventilation

• Spontaneous

• IPPV

• Dont need to stop start breathing
• RR good guide to degree of pain
• BUT
• Prone to hypoventilation

• Prevent atelectasis
• Can control ETCO2
• BUT
• Can cause barotrauma volutrauma
• Higher risk of awareness

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Monitoring Ventilation

Patient Parameters
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Monitoring Ventilation
Ventilator Parameters
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Monitoring

• Oxygen Saturations
• Monitors oxygenation not ventilation
• End-Tidal CO2
• Measures adequacy of ventilation
• Confirms circuit is intact that patient has CO

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• Tidal Volume 8-10mls/kg

• Frequency 10-12/min
• FiO2

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Post- Operative

• Respiratory compromise may be caused by many
  factors
• Patient factors pre-existing lung disease
• Anaesthetic factors high epidural, high dose
  opiates
• Surgical factors diaphragmatic splinting
• May need to keep some patients intubated on ICU
  post-op

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Summary

• A good pre-operative assessment is essential
• Get respiratory function as good as possible
  pre-op
• If youre worried about ventilation
  intra-operatively the monitors should give you an
  idea where the problem lies