關於臨床氣喘患者的問題 - 手術

Incarcerated Hernia才對
: ，right side。病人需緊急手術，採用全身麻醉，手術結束後，病人發生嚴重的氣喘，藥
: 物處理又，送加護病房觀察。病人平常一天抽兩包煙，且有高血壓與糖尿病，如果病人術
: 前有作肺功能測試，可能會有什麼結果，怎麼判讀？手術後再做一次肺功能，結果可能會
: 有什麼不同？如有不同，為什麼？

Int J Chron Obstruct Pulmon Dis. 2007;2(4):493-515.

Perioperative medical management of patients with COPD.
Licker M, Schweizer A, Ellenberger C, Tschopp JM, Diaper J, Clergue F.

Service d'Anesthésiologie, Hôpitaux Universitaires de Genève, Genève,
Switzerland. [email protected]

Abstract
Chronic obstructive pulmonary disease (COPD) and heart diseases are
considered independent risk factors for mortality and major cardiopulmonary
complications after surgery. Coronary artery disease, heart failure and COPD
share common risk factors and are often encountered,--isolated or combined--,
in many surgical candidates. Perioperative optimization of these high-risk
patients deserves a thorough understanding of the patient cardiopulmonary
diseases as well as the respiratory consequences of surgery and anesthesia.
In contrast with cardiac risk stratification where the extent of heart
disease largely influences postoperative cardiac outcome, surgical-related
factors (ie, upper abdominal and intra-thoracic procedures, duration of
anesthesia, presence of a nasogastric tube) largely dominate patient's
comorbidities as risk factors for postoperative pulmonary complications.
Although most COPD patients tolerate tracheal intubation under "smooth"
anesthetic induction without serious adverse effects, regional anesthetic
blockade and application of laryngeal masks or non-invasive positive pressure
ventilation should be considered whenever possible, in order to provide
optimal pain control and to prevent upper airway injuries as well as lung
baro-volotrauma. Minimally-invasive procedures and modern multimodal
analgesic regimen are helpful to minimize the surgical stress response, to
speed up the physiological recovery process and to shorten the hospital stay.
Reflex-induced bronchoconstriction and hyperdynamic inflation during
mechanical ventilation could be prevented by using bronchodilating volatile
anesthetics and adjusting the ventilatory settings with long expiration
times. Intraoperatively, the depth of anesthesia, the circulatory volume and
neuromuscular blockade should be assessed with modem physiological monitoring
tools to titrate the administration of anesthetic agents, fluids and
myorelaxant drugs. The recovery of postoperative lung volume can be
facilitated by patient's education and empowerment, lung recruitment
maneuvers, non-invasive pressure support ventilation and early ambulation.


J Asthma. 2006 May;43(4):251-4.

Asthma, surgery, and general anesthesia: a review.
Tirumalasetty J, Grammer LC.

Division of Allergy-Immunology, Northwestern University Feinberg School of
Medicine, Chicago, Illinois 60611, USA.

Abstract
Over 20 million Americans are affected with asthma. Many will require some
type of surgical procedure during which their asthma management should be
optimized. Preoperative assessment of asthma should include a specialized
history and physical as well as pulmonary function testing. In many asthmatic
patients, treatment with systemic corticosteroids and bronchodilators is
indicated to prevent the inflammation and bronchoconstriction associated with
endotracheal intubation. The use of corticosteroids has not been shown to
adversely affect wound healing or increase the rate of infections
postoperatively. Preoperative systemic corticosteroids may be used safely in
the majority of patients to decrease asthma-related morbidity.

下次PBL作業要自己做哦

這PAPER一大堆 隨便找都有 重要的是訓練解決問題的過程
如果這樣的問題就上來問 那這條路你會走得很辛苦 不然就是病人很辛苦

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