Respiratory  system

 

Enquire specifically about symptoms of:

  • chronic obstructive lung disease;
  • emphysema;
  • asthma;
  • infection;
  • restrictive lung disease.

Patients with pre-existing lung disease are more prone to postoperative chest infections, particularly if they are also obese, or undergoing upper abdominal or thoracic surgery. If an acute upper respiratory tract infection is present, anaesthesia and surgery should be postponed unless it is for a life-threatening condition.

 

Assessment of exercise tolerance

 

An indication of cardiac and respiratory reserves can be obtained by asking the patient about their ability to perform everyday physical activities before having to stop because of symptoms of chest pain, shortness of breath, etc.

For example:

  • How far can you walk on the flat?
  • How far can you walk uphill?
  • How many stairs can you climb before stopping?
  • Could you run for a bus?
  • Are you able to do the shopping?
  • Are you able to do housework?
  • Are you able to care for yourself?

The problem with such questions is that they are very subjective and patients often tend to overestimate their abilities!

 

Other conditions which are important if identified in the medical history:

  • Indigestion, heartburn and reflux Possibility of a hiatus hernia. If exacerbated on bending forward or lying flat, this increases the risk of regurgitation and aspiration.
  • Rheumatoid disease Limited movement of joints makes positioning for surgery difficult. Cervical spine and tempero-mandibular joint involvement may complicate airway management. There is often a chronic anaemia.
  • Diabetes An increased incidence of ischaemic heart disease, renal dysfunction, and autonomic and peripheral neuropathy. Increased risk of intraand postoperative complications, particularly hypotension and infections.
  • Neuromuscular disorders Coexisting heart disease may be worsened by anaesthesia and restrictive pulmonary disease (forced vital capacity (FVC) < 1 L) predisposes to chest infection and the possibility of the need for ventilatory support postoperatively. Care when using muscle relaxants.
  • Chronic renal failure Anaemia and electrolyte abnormalities. Altered drug excretion restricts the choice of anaesthetic drugs. Surgery and dialysis treatments need to be coordinated.
  • Jaundice Altered drug metabolism, coagulopathy. Care with opioid administration.
  • Epilepsy Well-controlled epilepsy is not a major problem. Avoid anaesthetic drugs that are potentially epileptogenic