Transcript Upper respiratory infection

URI AND ANAESTHESIA
DR.S.SUBBIAH., MNAMS., DA., MD., DCH.,
SENIOR CONSULTANT IN ANAESTHESIOLOGY,
APOLLO SPECIALITY HOSPITALS, MADURAI,
FORMER PROFESSOR AND HEAD
DEAPRTMENT OF ANAESTHESIOLOGY,
MADURAI MEDICAL COLLEGE, MADURAI
CONTROVERSIES
McGill – 1979 CHILDREN – 11 COMPLICATIONS
EASILY DESATURATED
2 TO 7 TIMES MORE COMPLICATIONS (11 TIMES)
POSTOPERATIVE INFECTIONS
POSTPONEMENT DUE TO URI
INCIDENCE & CAUSATIVE
ORGANISMS
500 MILLION OP, 2 MILLION IP, 8 MILLION
DAYS, 2 BILLION $
INCIDENCE MORE FREQUENT IN CHILDREN
RHINO, INFLUENZA, PARAINFLUENZA,
HERPES
TO BE DIFFERENTIATED FROM SERIOUS
ILLNESSES
PATHOPHYSIOLOGICAL CHANGES
INFLAMMATION
OEDEMA
SECRETIONS
AIRWAY HYPERREACTIVITY
AIRWAY REACTIVITY & PFT
INFLAMMATORY MEDIATORS:
BRADYKININ, PROSTAGLANDIN, HISTAMINE,
INTERLEUKIN
VAGAL AUTONOMIC REFLEX
VIRAL NEURAMINIDASE - ↑ AC.CHOLINE – MUSCARINIC
RECEPTORS
↓ NEUTRAL ENDOPEPTIDASE - ↑ TACHYCHININS
LARYNGO / BRONCHOSPASM – 4 TO 6 WKS – 7-FOLD ↑
WORSENED BY GA – RELIEVED BY IPPV
FEV1, FVC, VC ↓ - RESISTANCE ↑
RISK FACTORS
PARNIS PREDICTORS OF ANAESTHETIC
COMPLICATIONS:
1. AIRWAY INSTRUMENT – ETT > LMA > MASK
2. HISTORY OF COLD
3. STRONG SNORING
4. PASSIVE SMOKING
5. INDUCTION – THIO>HALO>SEVO>PROPOFOL
6. SPUTUM
7. NASAL CONGESTION
8. REVERSAL – NO REVERSAL > REVERSAL
OTHER RISK FACTORS
AGE < 5 YRS / PREMATURITY /
H/O REACTIVE AIRWAY DISEASE
AIRWAY SURGERIES
MALVIYA – OF 1078 CHILDREN
2 PNEUMONIAS
1 STRIDOR in the postop. Period
TWO DEATHS REPORTED –
EXTUBATION BRONCHOSPASM
CARDIAC ARREST
ANAESTHETIC MANAGEMENT
LIDOCAINE NEBULISATION
HYDRATION / HUMIDIFICATION / SUCTIONING
HALOTHANE / SEVOFLURANE
MILD CASES – AVOID INTUBATION
SEVERE SYMPTOMS – POSTPONE FOR 6 WKS
EMERGENCY – USE LMA
IF ET REQUIRED – ATROPINE, SALBUTAMOL
AWAKE EXTUBATION, AVOID DEPRESSANTS
COMPLICATIONS
COUGH, BREATH HOLDING, STRIDOR
SPASM – BRONCHO / LARYNGO
POSTOP. PENUMONIA
BRADY / TACHY ARRHYTHMIA
POSTOP. INFECTIONS
Alan Tait’s algorithm:
Surgery urgent
Yes
Proceed
No
? Infectious aetiology
Yes
No
Severe Symptoms
Yes
No or Recent URI
Postpone 4 wks
General Anaesthesia
Yes
Risk Factors ?
H/O asthma
Use of ETT
Copious secretions
Nasal congestion
• Parental Smoking
Surgery of airway
H/O Prematurity
Proceed
No
Other Factors
Need for Experience
Travelled far
Surgery cancelled prior
Proceed
Risk / Benefit ?
Proceed
Management
Avoid ETT
Use LMA
Pulse Oxymetry
Hydration
Humidification
Anticholinergics
Good
Poor
Postpone for 4 wks
TO SUMMARISE
RECOMBINANT NEUTRAL ENDOPEPTIDASE
ANTI VIRAL AGENTS
SPECIFIC M3 BLOCKER
POSTPONEMENT – INDIVIDUALISED
KNOWLEDGE OF THE COMPLICATIONS &
MANAGEMENT
2000 SURGERIES TO BE CANCELLED TO
PREVENT 15 SPASMS
"Common sense dictates that a patient with an
active but self limited disease not be subject to
elective anaesthesia and surgery until resolution
of the illness". – Statement by McGill in 1979.
“…although anesthesia may not be good treatment
for the common cold, might it not be a good way
of passing the time till the cold is gone?” - Ellis