64-year-old male for L4 laminectomy. Cancelled in anaesthetic bay 3/12 ago with SpO2 85% and HCO3 37
- Lower limb neurology due to spinal canal stenosis
- OSA/OHS – New diagnosis after last attempted surgery
- Now on BiPAP (IPAP 18, EPAP 10, backup RR 10), daytime SpO2 improved to ~90%, ESS reduced
- Obesity BMI 44
- Distant ex-smoker, nil COPD
- Mild asthma, distant puffer use.
- AMI 2014, medical mx, now discharged from cardiologist care
- unoptimised OHS?
- ABG in clinic – PaCO2 55, PaO2 63, HCO3 30
- Should procedure be postponed?
- Significant lower limb neurology, neurogenic claudication, and numbness
- Possible optimisation
- May require O2 addition to BiPAP to further stimulate respiratory drive (although recent overnight oximetry shows SpO2 ~90% on average).
- Consultation and further adjustment of BiPAP may be possible while inpatient post-operatively
- TTE to assess for cor-pulmonale due to OHS (difficult to assess due to limited mobility due to lower limb neurology, obesity, and chronic lower limb oedema).
- Proceed with OT
- Respiratory AT agrees with plan to proceed and asked to be notified on admission so that they can provide input postop.