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Clinical Anesthesiology, 4e
| Section IV. Physiology, Pathophysiology, & Anesthetic Management > |
Restrictive Pulmonary Disease
Sections: Restrictive
Pulmonary Disease, Acute Intrinsic
Pulmonary Disorders, Preoperative
Considerations, Anesthetic Considerations, Preoperative
Management, Intraoperative
Management, Chronic Intrinsic
Pulmonary Disorders, Preoperative
Considerations, Anesthetic Considerations, Preoperative
Management, Intraoperative
Management, Extrinsic Restrictive
Pulmonary Disorders.
Topics Discussed: anesthesia procedures; aspiration pneumonia; interstitial lung diseases; pneumonia; pulmonary disease, restrictive ; pulmonary edema; respiratory distress syndrome, acute; respiratory tract diseases.
Excerpt:
"Restrictive pulmonary diseases
are characterized by decreased lung compliance. Lung volumes are
typically reduced, with preservation of normal expiratory flow rates.
Thus, both FEV1 and FVC are reduced, but the FEV1/FVC
ratio is normal.Acute intrinsic pulmonary disorders include pulmonary edema (including
the acute respiratory distress syndrome [ARDS]),
infectious pneumonia, and aspiration pneumonitis.Reduced lung compliance in these disorders is primarily due to
an increase in extravascular lung water, from either an increase
in pulmonary capillary pressure or an increase in pulmonary capillary
permeability (see Chapter 49). Increased pressure
occurs with left ventricular failure, whereas fluid overload and
increased permeability are present with ARDS. Localized or generalized
increases in permeability also occur following aspiration or infectious
pneumonitis. Patients with acute pulmonary disease should be spared elective
surgery. In preparation for emergency procedures, oxygenation and
ventilation should be optimized preoperatively to the greatest extent
possible. Fluid overload should be treated with diuretics; heart
failure may also require..."
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