 In de volgende 2 lecturen gaan we oefenen in preoperative pulmonarie assessment. Nu, we talen over patiënts met nieke disease. Ze hebben aasma of, maat het, COPD, of ze at de risikoop van die postoperative complexie, en wat we talen is nemonie en spirituele failie. Maar we hebben eentwoordig goos. Nu, remember in de eerste set van lecturen waar we oefenen in die cardiocomplicaties. We hadden een mooi algoritme. In die algoritme hadden we nouds en we maakten beslings op die. En dan maakten we oefenen in die algoritme. We hadden nie die voor pulmonarie assessment. Er is eentwoordig aasma van die research evidence om ons wat te doen en hoe om die patiënts eentwoordig te oefenen. Dus wat we eentwoordig gaan doen is de risikoop van die. En de risikoop van die. Dus hier is een lang list van risikoop van die. Nu, niet alle hebben oefenen conclusief die risikoop van die. Nogmaals, die hebben en die ontbouden in online calculaties. En die zijn eentwoordig mooi, maar voor nemonie en spirituele failie. En we gaan ze in de tweede par. Maar hier is een lang list van die. Natuurlijk, het ouder die jouw patiënt is, de hoge incidenten van die onderling land probleem. En het worst die we gaan doen is, say, prolonged en aasetic. Dus die is eentwoordig. Pre-existing COPD. De patiënt van COPD is het hoge risikoop van die. Seguretuse. Nou, dat is goos. Voor meestal. Dan een patiënt met CCF, definitie. De functiele status. Dat patiënt die het eentwoordig is, dat kan't woordig, van oxigen en CO2 exchange. Dat patiënt die postoperatief probleem is. Heure ASA klas. Prolonged duration van de surgery. Zurt nie, er is eentwoordig, between 5, 6, 7 uur procedure en een quick 20 minute procedure. En dan ook de type van surgery. Nu, think about an epindesectomy versus upper abdominal gastric resection, say, for gastric cancer. Those two really are going to have different outcomes. Recent weight loss. Think about a patient with muscle mass loss. They're not going to be able to breathe properly postoperatively. They might not have the muscle strength to cough up their secretions postoperatively. Then long term steroid use. They're going to have the muscle mass problem, but they're also going to have an immune problem. They're not going to be able to fight infection and we might have postoperative complications. And the same really would go for alcohol use. So a good history and clinical examination. Ask the patient about pre-existing disease. Ask about specific symptoms. Coffing, dyspnea, orthopnea. Ask about these things. Ask about their medication. Ask about smoking. And we'll get to this a bit later. Do you smoke? They say no, I don't because they just stopped yesterday that of course doesn't count. Be careful, do a thorough examination and take a thorough history. So here's a little rule of thumb. It's not an algorithm at all, but first of all as with anything. If the surgery is of an emergency nature and it is life saving, you've got to go ahead with it. There's no need to waste time with tests. There's really no sense in that. But if a patient has known pulmoni disease and they are not at baseline, in other words they say I've got asthma. But I'm on medication. These are the number of attacks I get. It hasn't changed recently. I'm not coughing more. I haven't developed more dyspnea say for instance for the COPD patient. They're at their baseline. There's no need for investigation of that patient pre-operatively. But if they're not at baseline or they have unexplained dyspnea or exercise intolerance, those you have to investigate. So what investigations are we going to do? We're going to consider two tests. And as I said in part two, we're going to look at these beautiful risk calculators. So there's your two tests, pyrometry and a chest x-ray. Now pyrometry is really an excellent diagnostic tool. Make a diagnosis of many lung conditions. It's also very useful in monitoring therapy. The patient's being diagnosed. They're on therapy. We want to look at the success of that therapy. Do we need to change therapy so we can just follow them up? But it's not really a good predictor of postoperative outcome. There is some sparse evidence to suggest if there is an FEV 1 of less than 61%, that there might be an increase to risk, but the evidence is really not that good. Chest x-ray, it's just a knee-jerk reaction to order chest x-ray pre-operatively, especially above a certain age. Many units have that. And if suddenly, if that is what your unit does, please stick with that. But there's some research that looked into this, taking a whole bunch of patients who's had chest x-rays and it actually shows that only 3% of these people who had pre-operative chest x-rays will actually have their management altered. 97%, we're just going to go straight to theater after all these tests and have their anesthetic. So it doesn't really lead to change in management and there's also some research to show that if you just compare patients who've had a chest x-ray versus those that don't, there's no difference in outcome between these two. So it's not that it really improves your patient's outcome. But it is on the tick list at most units after a certain age or in certain circumstances to get a chest x-ray. And stick with that. Just understand what the evidence for that is. Now, this is part 1 and part 2 we're going to start looking at one specific condition that we don't always think about and that is obstructive sleep apnea syndrome.