Rising air pressure in the lungs (Pplat) suggests worsening lung overinflation. Keeping Pplat below 30 cm H2O by prolonging exhalation may be needed, and higher carbon dioxide levels (hypercapnia) may have to be accepted. Taking patients off ventilators could worsen their condition, so inhaled bronchodilators may be needed more after extubation. Regional anesthesia is an excellent alternative to avoid putting tubes in the airway and improves lung function after surgery due to better pain control and diaphragm function. In the postoperative period, consider keeping patients deeply sedated when removing breathing tubes or giving lidocaine intravenously to suppress airway reflexes, and watch out
Rising air pressure in the lungs (Pplat) suggests worsening lung overinflation. Keeping Pplat below 30 cm H2O by prolonging exhalation may be needed, and higher carbon dioxide levels (hypercapnia) may have to be accepted. Taking patients off ventilators could worsen their condition, so inhaled bronchodilators may be needed more after extubation. Regional anesthesia is an excellent alternative to avoid putting tubes in the airway and improves lung function after surgery due to better pain control and diaphragm function. In the postoperative period, consider keeping patients deeply sedated when removing breathing tubes or giving lidocaine intravenously to suppress airway reflexes, and watch out
Rising air pressure in the lungs (Pplat) suggests worsening lung overinflation. Keeping Pplat below 30 cm H2O by prolonging exhalation may be needed, and higher carbon dioxide levels (hypercapnia) may have to be accepted. Taking patients off ventilators could worsen their condition, so inhaled bronchodilators may be needed more after extubation. Regional anesthesia is an excellent alternative to avoid putting tubes in the airway and improves lung function after surgery due to better pain control and diaphragm function. In the postoperative period, consider keeping patients deeply sedated when removing breathing tubes or giving lidocaine intravenously to suppress airway reflexes, and watch out
• Consider keeping Pplat <30 cm H2O by prolonging expiratory time. May
need to accept hypercapnia • Extubation may precipitate exacerbation. Inhaled β-agonists may be needed more frequently post extubation. • Muscle relaxants in addition to systemic corticosteroids may cause acute myopathy • Volatile anesthetics, propofol, and ketamine are bronchodilators Regional Anesthesia • Excellent alternative to avoid airway instrumentation • Neuraxial blockade improves postop lung function due to improved pain therapy and diaphragmatic function • Neuraxial blockade may reduce vital capacity and FEV1 (negligible under lumbar or low thoracic block and benefits of pulm function prevail) • Concern for bronchial constriction due to sympathetic blockade is not significant and unproven • Overall pulm function and pain control are improved with neuraxial blockade in pts with reactive airway disease. Postoperative Period • Consider deep extubation or lidocaine IV to suppress hyperreactive airway reflexes • Observe for postop bronchospasm 280