Lap chole and severe COPD

garychleung

PIG Meeting: 1st April 2021

79yo male for lap chole due to recurrent choledocholithiasis. Previously cancelled due to lack of theatre time. Spirometry performed on day of surgery (at clinic doctor’s request) but not followed up.

Background:

  • HTN
  • PVD
  • COPD
    • 200m on flat, 1 FOS
    • Community acquired pneumonia 2020
    • Patient feels he’s at his baseline, nil exacerbations since 4-5/12
    • On Spiriva and salbutamol
    • FEV 1 0.62 (30%)

Discussion:

  • Indications for spirometry?
    • Surgery type – thoracic surgery, major open abdo
    • Patient factors: 
      • COPD +  intermediate or major surgeries
      • Smoker (>20 years) having intermediate or major surgeries.
      • Uncontrolled asthma.
      • Neuromuscular disorders e.g. M.N.D, Myasthenias)
      • Unexplained shortness of breath.
      • Patients having Consultations for ‘Suitability for Surgery’.
      • At discretion/ request of Anaesthetist rostered in clinic or Procedural Anaesthetist
  • What are the risks? Should surgery proceed?
    • ARISCAT, GUPTA (HAP), GUPTA (resp failure) scoring systems all suggests this man’s risk of respiratory complications is low given the laparoscopic nature of surgery.
    • Without surgery he may experience critical illness due to recurrent stones

Plan:

  • Proceed with OT
  • Notify the procedural anaesthetist