PIG Meeting: 18th February 2021
67 year old lady for elective laparoscopic Cholecystectomy
- Recent admission for obstructive cholangitis
- Moderate-severe COPD.
- Current smoker
- Recent deterioration in exercise tolerate to 20-30m. NYHA class 3 dyspnoea.
- Spirometry significantly deteriorated from previous. FEV1 = 0.63 (30% pred), FVC 0.94.
- No active infection
- On Clozapine under psychiatry care for schizophrenia
- Are there any alternatives to surgery? ERCP and sphincterotomy or stent?
- Requires further discussion with surgical team, laparoscopic cholecystectomy is usual pathway for these patients
- Requires respiratory assessment and optimization. Potential benefits of perioperative steroid therapy
- Cardiac assessment given on clozapine? Has echocardiogram booked to review any possible cardiac complication of clozapine therapy
- Suggestion of potential benefits of preoperative hospital admission for respiratory optimization
- Smoking cessation discussed
- Defer for 4 weeks while awaiting respiratory review and echocardiogram
- Further discussion with surgical team regarding respiratory co-morbidities and surgical options
- Liaise with psychiatry team given current clozapine therapy