Respiratory medicine
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Bronchoscopy is a procedure that is likely to provoke anxiety as the patient is surrounded by monitoring and bronchoscopy equipment, and care is administered by strangers who perform intimate, invasive, and sometimes, painful procedures. Sedation is needed, therefore, to allay anxiety and reduce stress, improve patient comfort and co-operation, provide amnesia and facilitate the bronchoscopic procedure. In this review we try to summarize the current knowledge on currently used sedation protocols with special reference to the commonly used pharmacological agents. We believe sedation should be used routinely in fiberoptic bronchoscopy in order to achieve a safe and pleasant procedure for both the patient and the pulmonologist.
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Respiratory medicine · Dec 2000
Role of spirometric and arterial gas data in predicting pulmonary complications after abdominal surgery.
The aim of this study was to evaluate the predictive value of preoperative spirometric and arterial gas data on severe pulmonary complications (PC) after elective abdominal surgery. We retrospectively studied 480 patients, 254 males and 226 females, mean (SD) age 63 (11) years, at risk for PC according to standardized criteria, who underwent laparotomy for resection of gallbladder for gallstones (44% of patients), resection of colon, rectum or stomach for malignant tumours (37%), and other abdominal surgery (19%). The overall incidence of postoperative PC was 18%. ⋯ Ischaemic heart disease (OR=3.44, 95%CI=1.08-10.93), operation for malignant tumours (OR=3.24, 95%CI=1.75-6.00) and age (OR=1.04, 95%CI=1.00-1.08) were also independent predictors of PC. Patients with moderate-to-severe airway obstruction combined with hypoxaemia had a significant higher risk of PC in comparison with patients with a normal respiratory pattern. Taking into account age, type of operation, and comorbidity, a preoperative respiratory functional assessment could be useful in identifying an increased risk of major PC in selected patients.