Impact of respiratory impairment on procedures

In this topic, the term ‘procedure’ is used to refer to any operation or procedure requiring general anaesthetic or procedural sedation.

There are risks involved when patients with respiratory disease have a procedure. Specific interventions or precautions may be required before, during and after a procedure.

Patients with respiratory disease need proper assessment before a procedure.

During the procedure, general measures that may reduce the risk of complications include using regional anaesthesia, assisted ventilation, targeted oxygen therapy, effective intra-airway suction to remove secretions, and using opioids and sedatives with caution and only as required.

In the postprocedural period, respiratory-related morbidity and mortality are increased because of:

• increased demand on the respiratory system: demand is increased because postprocedure fever, sepsis and tissue repair cause the basal metabolic rate to increase two- to three-fold, which increases oxygen consumption and carbon dioxide production
• reduced ventilatory capacity of the respiratory system: pain from abdominal or thoracic wounds, the need to remain supine, and the use of opioids and sedatives can contribute to reduced ventilatory capacity. Atelectasis, sputum retention, pneumonia and fluid overload can also reduce ventilatory capacity, as well as adversely affecting gas exchange.