The Perioperative Interest Group (PIG) Meeting is held every Thursday at John Hunter Hospital 12:30 to 1:30. The meeting is an informal discussion of perioperative issues, interesting cases from the clinic, theatre or elsewhere with a perioperative flavour.
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Perioperative Talk 
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For PIG notes 20th Feb 2020
Patient for pneumonectomy
-I agree that VQ scan must be performed to confirm suspicions of surgeon that the left lung is not contributing before embarking on this big procedure.
-She could also get a CPET, with VO2 peak >15mls/kg/min helping to rule her in for surgery
In regards patient with AF before hip surgery from 26th of April.
Everyone has bad cases they remember. But while I was training a man in his 60’s was noted to be in AF prior to prostate surgery. Asymptomatic, did see a cardiologist and was allowed to go to surgery without being anticoagulated. He had a massive embolic stroke on table and died in hospital.
A death following elective surgery from something that was potentially preventable was a terrible outcome. Following this case all patients at that hospital were delayed by 8-12 weeks following a new diagnosis of AF, for anti-coagulation if appropriate. Im not trying to present a definitive statement on management, simply present an extreme case to provide extra thoughts.
Just in regard the patient with suspected pulmonary hypertension and low haemaglobin for cystoscopy.
Anaemia reduces your viscosity, which is factored into the Doppler calculation for measuring peak pressure. A low haemoglobin of this level may represent a situation where the right ventricular peak pressure is being overestimated. All Doppler measures must be considered in context and can be recalculated factoring in a reduced viscosity, although this also would be guessing too (e.g. 2V square instead of 4 V square where V is velocity).
June 1
Regarding patient for uterine surgery fev0.4. Good outcome, but wondering about discussion of CSE in case of longer surgery and spinal failure, as per previous. Then Thrive and props sedation during case…..Wondering about patient weight with fev1 0.4. What was this expected as a % though days of 88 make me nervous.
Re stress testing
Also re sestamibi- previous advice from cardiologist stating the potential miss of severe left main disease- possibly better picked up on stress Echo…..also better dynamic pictures of heart under strain- alas, patient has to manage treadmill/bike…we mustn’t forget that iffy sestamibi we can jump to CT coronary angio if we think it’s of benefit…though cardiologist conversation is usually what I do
Hi Andew,
Just responding to your questions regarding severe COPD for gynae surgery. The pt weight was 47kg and the spiro results were FEV1 0.4 (30%), FVC 1.24 (70%), fev1/fvc 32%. The surgeons predicted the surgery would take ‘1-2hrs max’ so I didn’t think a CSE would be more beneficial than just a straight spinal. My concern was her being able to tolerate the lithotomy position with her level of respiratory distress. In hindsight, this was probably why she required a GA during her last spinal & gynae surgery. I definitely would have used thrive should I chosen to give her a spinal. In the end, after discussion with colleagues I opted for GA which turned out to be a better choice as she really struggled lying flat for induction due to lots of coughing. She did have a few rough days postop due to low hb, dyspnea & further cp but was discharged home approx 9 days later
With respect to the bigeminy and bradycardia what are you looking for when you request the echo? The holster make sense…
The presence or absence of structural heart disease would influence further management. Bigeminy in a patient with a structurally normal heart has a good prognosis. Bigeminy in a patient with prior infarction or structurally abnormal heart have increased risk of sudden cardiac death. If there were evidence of structural heart disease or previous MI on Echo – Cardiology consultation and management may be appropriate.
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