Mobsley's Mohicans: a tale of two terms by Harold Avery
By Harold Avery
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WHO df: a systolic blood pressure > 160 mmHg and/or a diastolic blood pressure > 95 mmHg. Mild controlled hypertension poses no additional operative risk but uncontrolled hypertension has a 30% risk of congestive cardiac failure or myocardial infarction in the preoperative period. Elective surgery should be curtailed if the diastolic blood pressure >115 mmHg as a diastolic blood pressure >120 mmHg has a well-documented association with preoperative complications. Pre- and Postoperative Aims Assessment and optimization of blood pressure control.
1). RV = Residual volume; ERV = expiratory reserve volume; TV = tidal volume; IRV = inspiratory reserve volume; FEV1 = forced expiratory capacity in 1 second; FVC = forced vital capacity. FEV/FVC ratio: usually >85%; <50% indicates that postoperative ventilation is more likely; and Maximum mid-expiratory flow rate (MMEFR) Peak expiatory flow rate (PEFR) measures airflow obstruction at high flow rates. Arterial blood gas estimation provides information as to baseline levels of gas transfer and helps guide therapy.
Assessment of associated pathology: coronary disease, congestive failure, renal dysfunction, peripheral vascular disease and coronary disease. Anaesthetic management: accurate monitoring of blood pressure, management of intubation hypertension and observation of intraoperative hypertension or signs of ischaemia. Postoperative management: optimise pain control and blood pressure management prior to return or oral medication. Respiratory System Patients at Risk of Postoperative Pulmonary Complications5 Condition Mechanism Obesity Reduced functional residual capacity Chronic obstructive airways disease Secretional airway obstruction from bronchorrhoea and absence of ciliary activity Chronic smokers Secretional airway obstruction from bronchorrhoea, diminishes ciliary activity, carboxyhaemoglobinaemia Restricted airways disease Diminished vital capacity Elderly and enfeebled Aspiration Assessment of Respiratory Function Clinical estimation of the forced expiratory volume in 1 s (FEV1) gives a good index of the severity of airways obstruction.