Summary

In study session IV you have learnt

• Respiratory disease is pathological conditions affecting the upper respiratory tract which ranges from self limiting common cold to severe pneumonia and lung cancer. Patients with respiratory disease have an increased chance of developing complications perioperatively.
• Upper respiratory infection is a term for almost for any kind of infectious disease process involving the nasal passages, pharynx, and bronchi. The viral infection of the respiratory tract causes inflammation and edema of the nose, throat and lower airways. This causes airway obstruction and increased airway reactivity and is responsible for the cough, laryngo and bronchospasm.
• Asthma is a disease characterized by chronic airway inflammation, reversible expiratory airflow obstruction in response to various stimuli, and bronchial hyper reactivity.
• General anesthesia may cause a patient with limited respiratory reserve to develop respiratory failure.
• Upper abdominal surgery limits their ability (pain) to take deep breaths and increases the risk of postoperative pulmonary complications.
• General assessment of the patient which involves history, examination and investigation should be done preoperatively. A medical specialist, surgeon, senior anesthetist may help you in examination, interpreting investigation and the need for referral or to proceed will be decided after consultation.
• In general, children presenting with symptoms of an uncomplicated URI and who are afebrile with clear secretions and appear otherwise healthy, or those with noninfectious conditions, should be able to undergo surgery; if you have the experience, the necessary anesthetic agents and adjunct to manage this specific patient.
• Children with more severe symptoms including mucopurulent secretions, productive cough, fever -38°C, lethargy, or signs of pulmonary involvement should have their elective surgery postponed for a minimum of 4 weeks and should be placed on antibiotic therapy.
• Patients with mild and well-controlled asthma can be safely anesthetized with any technique, as long as airway irritation is minimized. For example, general anesthesia through a face mask and laryngeal mask airway is less stimulating to the airway than through an endotracheal tube.
• When asthma is poorly controlled, regional techniques are ideal for peripheral and lower abdominal surgery.
• If general anesthesia is chosen for asthmatic patient, additional inhaled bronchodilator therapy immediately prior to induction of anesthesia is effective in blunting the onset of bronchospasm.