Summary

THE ROLE OF AGE , SEX AND ENVIRONMENT IN THE UPPER RESPIRATORY TRACT INFECTION , ALLERGY AND HYPERTENSION

WHAT ARE THE EFFECTS OF THESE DISEASES IN RELATION TO GENERAL ANAESTHESIA

RESEARCHER Dr. IKBAL NAEEM AL-LAMI ANAESTHETIOLOGIST

SUMMARY The upper respiratory tract infections,allergy and hypertension are common in this town among outpatients .There are many risk factors which increase the incidence of these diseases in this town becouse of dietary habits,high percentage of humidity becouse it lies near the beach and surrounded by the desert.the females are more affected than males and the paediatrics are more affected than adults in relation to upper respiratory tract infections and allergy.The females are affected more than males and the old age group more than young in relation to hyertension. İn relation to GA,the role of these diseases are very important with its complications intra –operatively or post operatively.

INTRODUCTION: As outpatients, there are different cases with different illnesses,but the most common are upper respiratory tract infections ,allergy,and hypertension.The effect of age,sex and environment in relation to these diseases and there effect in GA will be studied here.

METHODS AND MATERİALS : 231 patients were studied as outpatients.They are complaining of different illnesses,different age groups,sex and exposed to the same environmental hazards.

AGE GROUPS : In relatıon to URTI and allergy: Paediatrics=(1.5-14)years Adults= (15-70) years In relation to hypertension : AGE GROUPS: Young and middle and age groups =(20-50) years. Old age group=(50-80) years.

STATISTICS : Among 231 patients : 77 patients are complaining of URTI and alergy . 44 females patients , 33 males patients . 8 patients are coplaining of allergy . 45 patients are coplaining of tonsilitis . 25 patients with hypertension . 15 females patients . 10 males patients . AGE GROUPS in relation to URTI and allergy : Paediatrics : 40 patients . Adults : 37 patients . In relation to hypertension : 25 patients . Young and middle age group = ( 12 ) patients . Old age group = ( 13 ) patients .

RESULTS: In relation to URTI and allergy Tonsillitis is the most common Females patients are more affected than males Paediatrics are more common affected than adults. 33.333% patients with URTI and allergy 58.44% are with tonsillitis. 10.38% with allergy 57.1428% are females patients 49.3506% are males patients 51.948 % are paediatrics 48.0519 are adults In relation to hypertension : 25 patients are complaining of hypertension . The females are affected more than males . The old age group are more affected than the others . 10.8225 % patients are affected with hypertension . 60 % are females patients . 40 % are males patients . 48 % are young and middle age groups . 52 % are old age group .

DISCUSSION : In general anaesthesia the effects of these diseases are very important in preparation of the patient for surgery and during and post operative complications . 1 – URTI a- Common cold is a viral ( infection ) resulting in an inflammatory

reaction of the lining of the upper respiratory tract , particularly the nasal mucosa .This is manifested as local vasodilation , increased blood flow , edemas and a watery discharge from the nose . b- Sinusitis : the air sinuses within the face bones and

communicating with the nose become inflamed in the coryza and constant nose blowing forced nasal discharge into the space . c- Allergic rhinitis : this occurs as result of exposure to allergens .

It can be seasonal ( pollen ) or perennial ( house – dust mite ) . Symptoms are similar to cold but the conjuctive bay also be involved . d- Laryngitis and bronchitis : Laryngitis is common disease mostly

viral , recurrent laryngitis may causes vocal cords fibrosis and hoursness of the voice . Bronchitis : chronic or recurrent increase above the normal in the volume of mucus secretion sufficient to expectoration when this is not due to localized bronchopulmonary disease . More common in middle to late adult life and in men more than women . 2- Asthma : periodic attacks of breathlessness due to a reversible increase in the

resistance to asir flow through

the airways within the lungs .

Aetiology :

a- Extrinsic asthma : Atopy is an inherited predisposition to develop immunoglobuline E ( IGE ) antibody in response to various antigens ( allergens ) . Children are affected more than adults . Females are more affected than males . The most common aggravating factor is humidity and sands . b- Intrinsic asthma : The onset occur later . The most common predisposing factors is viral or bacterial infection e.g. exacerbation of chronic bronchitis .

HYPERTENSION : Is a complex condition charachterized by excessive resting BP readings greater than 140 mm HG systolic and 90 mm HG diastolic are excessive in young people . The disease is affected the old age more than the other age groups , in this study old age is 52 % , while middle and young age group are 48 % . Most of surgical patients above 40 years of age are hypertensive here because of diatary habits and lack of exercise , so in preoperative management and intraoperative , this point should be taken in consideration . The predisposing factors here are : 1-

Obesity .

2-

Lack of exercise .

3-

Fatty diet .

4-

Lack of knowledge of periodic checking of blood

pressure . Regarding URTI , it is better to treat them before surgery in such conditions

,

the

patients

‘

condition

will

be

worse

with

anaesthesia , so we have to study the anatomical structures separately to know the anaesthetic effects . 1- The nose : the adults patient breaths through the nose , in

normal subjects resistance created by breathing through nose is 1.5 times than oral breathing . Any obstruction to the nostrils or thickening of the septum, may prevent passage of all , but

small

endo

tracheal

tubes

,

so

before

attempting

nasal

intubation is advisable to test the patency of each nostrils in turn by listening for the sound that indicates agree flow of air . The infection can affect the stiff hairs in the interior part of nasal fosse which acts together with the spongy mucus membrane and the ciliated epithelium comprise a powerful defence mechanism against invasion of any organism . warming and humidification of inspired gases or air is also affected infection , so by giving anaesthesia , the condition will be worse because as a result of end tracheal intubation , only relatively dry gases or air reach to the lower part of trachea , so the end result is mild trachitis . Vocal resonance is affected by infection and by anaesthesia because it’s influenced by nasal passage patency .

2- The effect of premeditations , intubations , and dry gases all

will worsen the condition because it will be a process of inflammation while in presence of URTI there is already inflammation , so the end result is trachitis and bronchitis and then pulmonary collapse especially if the patient has bronchitis because here the intra and post operative complications are more

because

anaesthesia

presence

with

of

infection

accumulation

of

and

the

secretion

effect will

of

cause

formation of lung abscess with all it’s complications . also bronchitis

(

chronic

)

can

stimulate

bronchospasm

in

aneasthetized patient because of stimulation by chemical or mechanical factors or even neural . In clinical practice , the most common problem prior to surgery is chronic bronchitis because of smoking and high incidence of allergy and asthma which predispose to chronic bronchitis ( here in this town ) but according to the results as outpatients , tonsillitis is the most common both acute or chronic . In case of acute tonsillitis the patient will be feverish , so if elective , we can treat him , then prepare him for surgery .But in emergency , the tonsils are edematous and follicular , filled with puss , so it is difficult to incubate the patient because any trauma

can

drain

the

puss

and

the

patient

is

already

anaesthetized and fully relaxed , so this puss can transmitted to the trachea and causes trachitis with it’s complications , poor hygiene is one of the major causes of URTI and tosilitis especially high incidence here because of poor hyojen . The premedication drugs like Atropine can cause tachycardia and with another drugs will effect the patient’s condition while the patient is feverish so it is another problem here .Allergy and asthma as mentioned before high incidence and mostly the females are affected more than males most probably because of house dust mite , but generally for the patient who are

prepared for surgery , good history and examination must be done and investigations like ECG and X-ray prior to surgery , lung function test , with treatment , but if the attack is precipitated

by anaesthesia , so aminophyline 250 mg IV

slowly with hydrocortizone 100 mg IV must be given with good monitoring to arterial blood gases . Certain drugs must be avoided in asthmatic patient during anaesthesia like opiods (

Morphine

and

Fatanyle

)

,

sedative

(

Diazepam

,

Barbiturates ) , B-blockers like propranlol should be avoided also . If status asthmaticus occurred post operatively ?

1- Immediate treatment : Aminophyline slowly IV ,

Hydrocortizone Sodium Succinate IV and nabulized Salbutamol 4 hourly .Humidified O2 can be delivered by ventimask 35 % ( more than 60 % inspired concentration damage lung ) . Dehydration should be corrected . If the patient deteriorates , IPPV and bronchial lavage may be necessary . 2- After initial improvement administer oral predinsolon and

continue nebulized Salbutamol . Effects on mediator release from mast cells important at this stage . Physiotherapy helps to dislodge plugs of tenacious mucus . 3- Reduce dose of predinsolone generally to zero ( or to low

maintainance dosage ) . Reinduce outpatient maintainance therapy .

HYPERTENSION : Common illness in this town because of many factors which were mentioned here before .Still the old age groups are more affected than young age group but females are more affected than males because of lack of exercises and obesity is more than males , stress also here

is more common in females than

males , usage of contraceptive pills is also an important factor in addition to pregnancy which causes justational hypertension . In anaesthesia : 90 % of patients which are prepared for surgery above age of 40 years are hypertensive , so pre operative examination is very important , sedation must be given , Diazepam is the most common one tab at night ( 10 ) mg and then recheck BP at the morning because anxiety raises blood 10 mg IV , if still , high medical

consultation

must

be

done

if

the

physician

decided

antihypertensive drugs , so the operation must be canceled until the BO is controlled . If emergency : 1- Diazepam 10 mg IV , if not available , so : 2- Dormicium 5 mg IV . 3- Pethidine 50 mg IV . 4- Fantanyle 0.1 mg IV .

As premedications with Atropine 0.6 mg IV. Regular monitoring of blood pressure intra-operatively, if the blood pressure is raised again , so Nifidipine ( 5 – 10 ) mg S.L. and continues monitoring of BP, e,g. : –

Induction agent : Ketamine must be avoided .

–

Usage of Xylocain spray 4 % to spray the larynx and trachea before endo tracheal intubations.

–

Avoidance of Pacuronium .

–

Prevent any painfull stimulation by giving deep anaesthesia and good analgesia .

–

Smooth recovery .

–

P.o. analgesia e.g. Pethidine 50 mg or Fantanyle 0.1 mg IV.

–

P.o. monitoring of BP to prevent any sudden raise which will cause serious complications .

CONCLUSION : These diseases are the most common among outpatients but it gives an idea about it’s effect on patients who are prepared for surgery . Because it is a small town , and it’s population not more than 100000 as anaesthesiologist , the patients are prepared to be given anaesthesia must expect serious complications intra operative and post operative with poor hyojen and lack of regular examinations make the condition worse , pediatric especially with URTI are more serious than adults , because of effect of anaesthesia . one case was admitted for surgery , the patient was not feverish , body temp. 37 c , no signs of tonsillitis but endo tracheal intubation , it was big tonsile , which affect intubations , the recovery by section of oral secretion , there was trauma and puss started to drain , that was an example , the same like with asthma which is already ventilation – perfusion mismatch with effect of anaesthesia , the condition will be bad , and in advanced chronic asthma , there is respiratory failure which is ver dangerous during anaesthesia . Hypertension has serious complications if not controlled before anaesthesia , intra-operative elevation of BP or sever hypotension can lead to CVA . Post operative can cause CVA or MI or other serious problem .

REFERENCES :

1- Basic Pharmacology : R.W.Foster – Second edition , P :

289,290,297,298,305 . 2- A practice of Anaesthesia : Whylie and Chuchil –

Davidson’s – Fifth edition , P : 25,27 . 3- Tidy’s Types of anaesthesia – P : 186 .