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Pulmonary Physiologic Assessment of Operative Risk

Pulmonary Physiologic Assessment of Operative Risk. UPPER ABDOMINAL SURGERY . Postoperative pulmonary collapse is related to diaphragm dysfunction, which is manifest in 50 to 60 % reduction in vital capacity for few hours to 5 days.

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Pulmonary Physiologic Assessment of Operative Risk

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  1. Pulmonary Physiologic Assessment of Operative Risk

  2. UPPER ABDOMINAL SURGERY • Postoperative pulmonary collapse is related to diaphragm dysfunction, which is manifest in 50 to 60 % reduction in vital capacity for few hours to 5 days. • Preoperative PFT( pulmonary function test )with spirometry is unproven to predict increased postoperative pulmonary risk.

  3. LUNG RESECTION SURGERY • If no lung is resected, the vital capacity declines 25% in early postoperative period and normalizes 4 to 6 weeks. • When normal lung tissue is resected, the first is reduction of the pulmonary capillary bed. If pulmonary dysfunction exists, pulmonary hypertension will lead to cor pulmonale and death.

  4. LUNG RESECTION SURGERY • The 2nd effect of lung resection is reduction of ventilatory capacity. • Inoperability means inability of tolerance after loss of functional lung tissue. • The mortality of pneumonectomy is less than 5%.

  5. Routine Pulmonary Function Studies

  6. Routine Pulmonary Function Studies • Ferguson et al reported DLCO( diffusing capacity of lung for CO ) was the best predictor of postoperative pulmonary complications. • DLCO measures the volume of diluted CO taken up by lung during a single breath held for 10 seconds.

  7. Split Lung Function Studies • Unilateral ventilation is measured by inhalation Xe133 and perfusion is measured by IV Tc99m albumin macroaggregates.

  8. Split Lung Function Studies • Postoperative FEV1= preoperative FEV1-preoperative FEV1 x % of function of tumor-containing lung X( no. of segments of resected lobe/ total no. of segments of the lung ) E.g. preoperative FEV1=2.0L right lung function=40% RUL lobectomy will be done. Postoperative FEV1 = 2.0-2.0x40%x3/10=1.76L

  9. Postoperative FEV1 • If radiospirometry is not done, then Postoperative FEV1= preoperative FEV1-preoperative FEV1 x 1/19x no. of resected segments E.g. preoperative FEV1=2.0L RUL lobectomy will be done. Postoperative FEV1 = 2.0-2.0x1/19x3=1.684

  10. Hemodynamic Studies • TUPAO( temporary unilateral pulmonary artery occlusion ): inflation of the 50-ml balloon in the main PA to induce a physiologic pneumonectomy • A PVR (pulmonary vascular resistance) is more than 190 dyne-sec-cm-5 than postoperative mortality is predicted.

  11. Exercise Test • Maximum oxygen consumption (VO2max) is measured.

  12. SUMMARY • The PFT appears to play a minor role in upper abdominal surgery and open heart surgery. • No patient should be rejected for curative surgery for lung cancer based solely on spirometric finding.

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