56-year-old lady with recurrent pancreatitis
- ‘Grumbling’ chronic pancreatitis over last 3 years
- Monthly symptoms and hospital presentations
- Lipase and LFT’s elevated
- Previous cholecystectomy
- Severe COPD and asthma- 26 pack year smoking history
- Severe mixed obstructive and restrictive defect on formal spirometry: FEV1/FVC = 0.71/1.66, Bronchodilator reversibility. TLCO 69%
- Multiple admissions with infective exacerbations of COPD
- Mild OSA
- NYHA Class 3 dyspnoea, walks 200-300m on flat
- Attended JHH for EUS pancreas a few weeks ago, waking from RNC to JHH door to gain entry to hospital and was dyspnoeic. A passing Dr noticed her respiratory distress and stopped to help her, called the gastroenterologist and the procedure was cancelled.
Opportunities for optimisation
- Discussed with regular respiratory physician, optimised from respiratory perspective, but suggests there may be room to improve dyspnoea with diuretics.
- Recent admission with infective exacerbation of COPD, she responded to a small dose of furosemide.
- BNP during admission = 982.
- Post-discharge, Sestamibi and TTE were normal.
- Awaiting appointment with cardiologist
Proceed to surgery?
- Patient at her baseline best, states that the dyspnoea she was experiencing was normal for her.
- Cardiology opinion useful in the long-term
- Cardiac investigations reassuring
- No benefit to repeating BNP, unlikely to change anaesthetic management
- Needs to be assessed for fluid status on DOS
- Proceed to surgery
- Discuss at cardiology MDT