84-year-old man with 5.9cm infra-renal AAA

Background

• Incidental finding on CT for urology
• BPH – recent cystoscopy under GA with no issues

Issues

• Undiagnosed COPD? Never seen respiratory physician, distant smoking history.
• SpO2 = 84% on room air, decreased to 87% following walk up 2 FOS
• Clinic spirometry: severe obstruction, FEV1/FVC = 0.59/1.78= 0.33
• HARD card – previous difficult intubation, and history of suxamethonium apnoea
• Hypertension = 183/92 in clinic

Discussion

Optimisation

• Referred to Rapid access respiratory clinic, appointment 4 weeks after planned surgery date
• Consensus that we should await respiratory review if surgeon happy with delay
• Needs formal spirometry – assessment of severity and bronchodilator reversibility
• Potential to improve pre-operatively with COPD therapy
• Download GOLD app at www.goldcopd.org for assessment and treatment algorithms

Conduct of anaesthesia

• GA -history of difficult airway and significant anxiety
• Most thought it would be prudent to secure the airway at the beginning of the case
• Discussed with surgeon, anticipates 2-hour surgical time

Plan

• Await respiratory review and formal spirometry