Pulmonary fibrosis:

 

Causes:

Idiopathic

·        Most common

·        Chronic injury to type 2 pneumatocytes

Medications

·        Amidoarone

·        Methotrexate

·        Bleomycin

Systemic disease

·        Rheumatoid arthritis

·        Sarcoidosis

Occupational

·        Asbestos

·        Silica

·        Dust

·        Mould

 

Diagnosis:

Hx

·        SOB

·        Dry cough

Ex

·        Fine end-inspiratory crackles

Ix

·        HRCT

 

Issues:

Lung disease

Risks:

·        T1RF: ↓FRC, impaired V/Q matching

·        T2RF: restrictive impairment, sensitivity to opioids

·        Pneumonia

·        Pneumothorax

Prevention:

·        Analgesia: regional, opioid-sparing, APS-run

·        Reversal: rocuronium -> sugammadex

·        Ventilation: ↑RR, ↑i-time, ↓VT, careful FiO2 and PEEP

(consider ICU ventilator)

·        Disposition: post-op HDU/ICU

Right heart disease

·        i.e. pulmonary hypertension, RV failure

·        See elsewhere…

Drug side effects

·        Immunosuppression -> risk of infection, wound breakdown

·        Adrenocortical suppression -> risk of Addisonian crisis

 

 

https://www.anesthesiaconsiderations.com/restrictive-lung-disease-considerations

 

Feedback welcome at ketaminenightmares@gmail.com