Pneumonia and its anaesthetia management PPT downlaod

In this PPT we have discussed the pathophysiology of the pneumonia and then the anaesthesia  considration, means how can we manage a patient with pneumonia. you can download this ppt also below you can read the transcript of this ppt also.

Pneumonia and its anaesthesia consideration PPT

Transcript of this ppt 

Slide 2

Table of contents 

•   Introduction to pneumonia

•   Types of pneumonia

•   Diagnosis of pneumonia

•   Treatment and prognosis

•   Management of Anesthesia

slide 3

Introduction to pneumonia                                       

• Pneumonia is an infection that affects one or both lungs.

• It causes the air sacs, or alveoli, of the lungs to fill up  with fluid or pus.

• Bacteria, viruses, or fungi may cause pneumonia.

• Symptoms can range from mild to serious and may  include a cough with or without mucus (a slimy substance), fever, chills, and trouble breathing.

• How serious your pneumonia is depends on your age, your overall health, and what caused your infection.

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Pathophysiology

slide 7

symptomps of pneumonia 

slide 8 

Types of pneumonia 

There are many types of pneumonia some of which are discussed briefly here;

• Community-acquired pneumonia

• Aspiration pneumonia

• postoperative pneumonia

• Ventilator associated pneumonia

slide 9

community acquired pneumonia 

• Community-acquired pneumonia is defined as pneumonia that is acquired outside the hospital.

• Combined with influenza, community-acquired pneumonia is one of the 10 leading causes of death in the United States.

• Streptococcus pneumoniae is by far the most frequent cause of bacterial pneumonia in adults. S. pneumoniae causes typical pneumonia.

• Influenza virus, Mycoplasma pneumoniae, chlamydia, legionella, adenovirus, and other microorganisms may cause atypical pneumonia.

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Aspirational pneumonia 

• Patients with depressed consciousness may experience aspiration that in  the presence of underlying diseases that impair host defense mechanisms  may manifest as aspiration pneumonia.

• Following are some causes of aspiration pneumonia

• Alcohol- and drug-induced alterations of consciousness, head trauma, seizures, Other neurologic disorders,and administration of sedatives are most often responsible for the development of aspiration pneumonia

• Penicillin-sensitive anaerobes are the most likely cause of aspiration pneumonia.

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post-operative pneumonia 

• Postoperative pneumonia occurs in approximately 20% of patients undergoing major thoracic, esophageal, or upper abdominal surgery but is rare after other procedures in previously fit patients.

• Chronic lung disease increases the incidence of postoperative pneumonia threefold.

•Other risk factors include obesity, age older than 70 years, and operations lasting longer than 2 hours.

slide 13

ventilator associated pneumonia 

• VAP is defined as pneumonia developing more than 48 hours after mechanical ventilation has been initiated via endotracheal tube or tracheostomy.

• Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in the ICU and makes up one-third of all nosocomial infections.

• Between 10% and 20% of patients who have endotracheal tubes and undergo mechanical ventilation for longer than 48 hours acquire VAP,with mortality rates ranging from 5%–50%.

slide 14
some pictures related to types of pneumonia 

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WHO classification and management 

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Diagnosis of pneumonia 

•       An initial chill followed by abrupt onset of fever, chest pain, dyspnea, fatigue, rigors, cough, and copious sputum production often characterize bacterial pneumonia.

•       Nonproductive cough is a feature of atypical pneumonia.

•       A detailed history may suggest possible causative organisms.

•       Alcoholism increases the risk of aspiration.

•       Patients who are immunocompromised, such as those with acquired immunodeficiency syndrome (AIDS), are at risk of fungal pneumonia, such as Pneumocystis pneumonia.

•       Chest radiography may be extremely helpful in diagnosing pneumonia.

•       Radiography is useful for detecting pleural effusions and multilobar involvement.

•       Consolidation can be seen on CXR.

•       Leukocytosis is typical, and arterial hypoxemia may occur in severe cases of bacterial pneumonia.

•       HIV infection is an important risk factor for pneumonia and should be ruled out when pneumonia is suspected. 

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Treatment of pneumonia 

• For severe pneumonia, empirical therapy is typically combination of antibiotic drugs. Antibiotic resistance should always be considered before initiating therapy.

• Therapy is advised for 10 days for pneumonia caused by S.pneumoniae and for 14 days for that caused by M.pneumoniae or Chlamydia pneumoniae.

• Bacterial Pneumonia Medication: Fluoroquinolones, Cephalosporins, Macrolides, Monobactams, Antibiotics Lincosamide, Tetracyclines etc.

• When symptoms resolve, therapy can be switched from the IV to the oral route. 

• It has recently been demonstrated that even brief administration  of a macrolide antibiotic such as azithromycin to healthy subjects  promotes resistance of oral streptococcal flora that lasts for  months.

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prognosis of pneumonia 

• The Pneumonia Severity Index is a useful tool for aiding clinical judgment, guiding appropriate management, and suggesting prognosis

 • Pneumonia severity index shows the severity of pneumonia and through this we can do management.

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Element of pneumonia severity index

slide 23 

Mnemonic for pneumonia severity index

For mnemonic of pneumonia severity index click here to learn and memorize the pneumonia severity index in few minutes.

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Pneumonia and management of anaesthesia 

• Anesthesia and surgery should ideally be deferred if acute pneumonia is present.

• Patients with acute pneumonia are often dehydrated and may have renal insufficiency.

• Fluid management can be challenging, since over hydration may worsen gas exchange and morbidity.

• If general anesthesia is used, a protective ventilation strategy is appropriate, with tidal volumes of 6–8 mL/kg ideal body mass and mean airway pressures of less than 30 cm H2O.

• The anesthesiologist can perform pulmonary hygiene, including actively removing secretions during the period of intubation, even with bronchoscopy if needed.

• Endotracheal intubation offers the opportunity to obtain distal sputum specimens for Gram stain and culture.

• Anesthesia of choice for  pneumonia  is regional.

• If GA is to be given then prefer to get /he surgery done under laryngeal mask airway (LMA).

• Avoid intubation as far as possible, however, if intubation is necessary then reflex stimulation of airways by laryngoscopy and intubation should be prevented.

• Use of anticholinergic is strongly recommended.

• Humidification of gases is must.

• Keep the patients for longer periods in postoperative room for respiratory monitoring.

 •   Positioning should be manage as weight loss occurs

•   Postop epidural analgesia karo

•   Intraaop position should be upright to prevent atelactesis

•   For better ventilation

•   All respiratory infections go for regional anesthesia