Perioperative Medicine

Perioperative Medicine

Surgery and Your Lung Health

Are you planning a surgery in the near future? If so, our FLASS specialists are here for you. Most people understand that the heart might give them problems before, during or after surgery. However, PPCs, also called postoperative pulmonary complications, happen just as often as cardiac complications.

Have you been diagnosed with a lung disease or condition?

If you have already been diagnosed with a lung problem, you have a greater risk of a PPC, no matter what type of surgery you are having. Therefore, as your perioperative care doctors, we can work with you to help reduce these risks during surgery. This way, if any unexpected complications do occur, you will have the advantage that we are already acquainted with your existing pulmonary problem, and your general medical history.

Often times, when serious pulmonary complications occur, we are called by the hospital in the midst of a crisis situation. However, if we are already involved in caring for your lungs, we can be with you step-by-step, before, during and after surgery. We are already involved in your care if complications occur at any point in your surgical journey.

A Quick Example: Atelectasis

Statistics show that up to 90 percent of patients develop some degree of atelectasis during anesthesia. If you are planning surgery, be aware of the term Atelectasis, which is when all or part of the lung collapses, or little areas of lung tissue don’t inflate appropriately.

Did you know that your necessary position during surgery or your specific anesthesia can intensify this common PPC? We will be on your team to take measures to prevent, offset or treat as much atelectasis as possible.

Pulmonary Precautions: Before Surgery

Before your surgery, we will take the time to discuss your medical history and evaluate your general and pulmonary health. Then, we will discuss various strategies to reduce your risks of specific respiration difficulties relative to your condition before the surgery. COPD, sleep apnea, or asthma should not deprive you of essential surgery, such as joint replacement or intestinal procedures.

With your pulmonary condition in mind, we can discuss plans ensure your surgery goes as smoothly as possible. You and your FLASS provider will discuss individualized, specific perioperative strategies that are relative to your particular lung condition.

Please See Us Before Surgery If You Have:

  • Periods of breathlessness (dyspnea)
  • A diagnosis of COPD, asthma or any chronic lung condition
  • Unexplained coughing spells
  • A history of congestive heart failure
  • The status of a current or former cigarette smoking habit
  • An age of 60 or more years

Our preoperative risk assessment consists of a few tests and a thorough medical history. This assessment can identify your risks of a PPC during or after your surgery.  For example, during our preoperative discussion, we might discuss smoking cessation in preparation for your surgery.

The FLASS Preoperative Checklist

Your FLASS physician conducting the preoperative evaluation will work with your primary care provider, oncologist, surgeon, anesthesiologist and other specialists. Below is a general checklist we use prepare you before your surgery. Of course, your customized list would be individualized for your condition.

What to expect before surgery…

  • We learn your functional capacity, determine your physical status and study your previous medical history of surgery and reactions to anesthesia.
  • We assess oxygenation and ventilation status, especially if you already suffer with a lung disease.
  • If you are a smoker, we help you get the assistance you need to stop smoking.
  • If you are obese or malnourished, we assist you in getting the help you need to manage your nutrition.
  • We check your medications and make sure they are administered immediately before, during and after surgery. We correct fluid and electrolyte levels. If you take bronchodilators, or diuretics, you need FLASS on your team.

Intraoperative Management: During Surgery

The term intraoperative refers to the time during your surgery. At this stage, we help your surgical care team protect your lungs, heart and brain. We are constantly alert for reactions between your underlying pulmonary conditions and the anesthesia.

What to expect during surgery…

  • We consult with the surgeon about the best surgical approach to avoid PPCs.
  • We help to manage medications. (Here’s where we watch atelectasis, mentioned above.) Some medications can contribute to PPCs if they decrease respiratory muscle tone or reduce the size of your airway.  We help the surgical team monitor oxygenation and ventilation.
  • Your FLASS physician will help design or manage a plan for your postoperative pain management.
  • We will proactively plan your possible needs regarding postoperative organ support.
  • In some cases, we recommend continuous positive airway pressure (CPAP) therapy throughout your surgery.

Postoperative Considerations of Your Lungs: After Surgery

After your surgery is complete and the anesthesiologist and surgeon have finished their work, we begin the postoperative tasks of your respiratory recovery. Perhaps you will go to your regular hospital room, or in the case of PPC’s, we may send you to ICU where we can more closely monitor your progress.

What to expect after surgery…

  • If you have other health problems such as diabetes, renal disease or a blood condition, rest assured. We will continue to monitor any health conditions as you leave the surgical suite.
  • If it has been necessary to place you on invasive mechanical ventilation, we will determine how soon we can begin removal of that machine. We do not want you to become dependent on mechanical ventilation.
  • We will also decide if you need supplemental oxygen, and how it should be delivered. Despite the popularity of the catheter under your nose, we might need to order a mask instead.
  • We can order such tests as arterial blood gas, pulse oximetry and end tidal carbon dioxide (ETCO).

Perioperative Care Considerations: The Big Picture

When you empower us to oversee your perioperative care, you strengthen your odds against PPC’s during your perioperative experience. Because we know you as an individual, we are better able to control your pulmonary problems. Florida Lung, Asthma and Sleep Specialists care team has the ability to optimize your respiratory status before, during and after surgery.

Both before and after your surgery, your pulmonary physician will often prescribe lung expansion maneuvers, especially if you are having high risk surgery. Much less invasive than they sound, these maneuvers might include some self-management techniques like incentive spirometry or deep breathing exercises.

We may also recommend Inspiratory Muscle Training (IMT) for either the time before or the recovery time after surgery, or bothIMT is nothing to fear. It is simply a customized exercise program in which you learn specialized breathing techniques.

Life after Surgery:  A Note For Our Perioperative Patients

Perioperative care involves a large cast of healthcare professionals: your primary physician, surgeon, anesthesiologist, your pulmonary specialist, your nursing staff, your inhalation therapists and the housekeepers who keep germs out of your environment. They all play a role on your journey through surgery into better health.

As a patient-centric organization, we never forget the star of the team: You. As the patient, you have the most difficult job on your healthcare team: Getting on your feet after surgery and taking those first shaky steps.

Sometimes those steps are made by your feet, and sometimes by just taking breaths. Because we support you as a whole person, we will support and applaud you each step of the way through your perioperative journey.

 

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