In this MRCS Part B scenario you are the surgical registrar. The anaesthetist for today’s list has some questions for you.
How can you reduce these?
I would divide these into Pre-op, intra-op and post-op factors:
1) PRE-OP - smoking cessation, optimisation of COPD medications, pulmonary rehab.
2) INTRA-OP – regional/local anaesthesia if possible.
3) POST-OP – adequate analgesia (to ensure that the patient can cough and the diaphragm is not splinted), chest physio (encourage deep breathing, CPAP, incentive spirometry) and early mobilisation.