The respiratory physician may be asked to assess a patient prior to elective or emergency surgery. These patients are usually those with pre-existing respiratory disease such as COPD.
• The usual functional status of the patient should be determined
• Their respiratory function should be optimized, if possible, with medication changes where appropriate.
These patients may require ventilatory support post-operatively. Ultimately, the decisions regarding fitness for surgery rest with the surgeon and the anaesthetist.
• Usual functional state and exercise tolerance (those with an exercise tolerance of <5m will not come off a ventilator)
• O2 saturations on air and after exertion such as walking or climbing up and down a step for 2min. Cardiopulmonary exercise test (CPET) may be necessary (see p. [link])
• ABG on air, if saturations <94%. Risk of surgery increases as the CO2 increases
• Spirometry, with bronchodilator reversibility testing. Risk of surgery increased if FEV1 <0.8L
• CXR—if 65+ and no CXR in last year, or if acute respiratory symptoms
• History of snoring or OSA
• Echo, if cardiac function compromised.
• Regular inhaled or nebulized bronchodilators, if airflow obstruction
• Regular inhaled steroid, if evidence of steroid reversibility
• Preoperative course of oral steroids, if evidence of steroid reversibility
• Preoperative course of antibiotics, if evidence of infection
• Consider pulmonary rehabilitation
• Consider chest physiotherapy with deep breathing exercises
• Referral for CPAP, if OSA present
• Optimize nutrition
• Lose weight
• Advise to stop smoking—ideally 8 weeks prior to surgery; reduces post-operative complication rate.