PIG Meeting: 13th May 2021
A 73yo female who had a C5/6 foraminotomy in 2015, and then a revision, now for 3rd surgery to same site.
- Obesity BMI 48
- PE 2017
- CKD eGFR 45
- IHD – MI 2001 -> CABG. Angio 2015 – moderate prox LAD dx, grafts patent. Admitted 2018 with stable angina and ED presentation 2020 -> discharged home after -ve trop and ECGs.
- On salbutamol – patient unaware of indication
- Distant ex-smoker
- Likely OSA – STOPBANG 6-7
- Severe SOBOE and weekly exertional angina (relieved by GTN)
- Lost to F/U from cardiologist
- ? Needs TTE/cardiologist review/stress imaging
- Nil pedal oedema, orthopnoea, PND
- Should consider further investigation of OSA risk. Note that potential significant waitlist for elective patients.
- Discussed at cardiology-anaesthetics meeting
- Reassured by previous angio images pre- and post-bypass
- Patient able to climb 20 steps up/down without stopping (SOB ++) so felt that low likelihood of significant lesion requiring revascularisation pre-surgery
- Nil TTE or stress imaging recommended.
- PFTs indicated?
- Severe obesity + deconditioning likely causative for SOB
- PFTs would likely show a restrictive pattern and mildly reduced diffusion
- Distant ex-smoker, nil resp exacerbations, nil other clear risk factors for severe, modifiable lung disease
- Low risk surgery in a high risk patient. ? yield from redo, redo surgery.