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preoperative health status

BOX 1-13

Management of Asthmatic Patient

1. Defer dental-treatment until asthma is well controiled
. and .patient has no signs of. a respiratory tract infection.
. 2. Listen to chest with stethoscopeto detect wheezing
before major oral surgical procedures orsedation.
3. Use .anxiety reduction protocol, including nitrous”
” . oxide; but avoid use of respiratory depressants. ,
4. Consu~ physit:j~n about possible use of preoperative
cromolyn “sodium. , ” .
.5., If patient is or has been’ chronically on corticosteroids,
prophylax for adrenal insufficiency (see page 17).
6. Keep a bronchodilator-containlnq.inhaler easily
accessible. ”
7. Ayoiduse of nohsteroldal antiinflammatory drugs
(NSAIDs) in susceptible patients

chospasm initiation and of the potential adrenal suppression in patients receiving corticosteroid therapy (see previous discussion). Elective oral surgery should be deferred if a respiratory tract infection or wheezing is present. When surgery is performed, an anxiety reduction protocol is followed; if the “patient takes steroids, the patient’s primary care physician can be consulted concerning the possible need for corticosteroid augmentation during the perioperative period. Nitrous oxide is safe to administer to people with asthma and is especially indicated for patients whose asthma is triggered by anxiety. The patient’s own inhaler should be available during surgery, and drugs such as injectable epinephrine and theophylline should be kept ~n an emergency kit. The use of the NSAlDs should be avoided because they often precipitate asthma attacks in susceptible individuals (Box 1-13).

ell nuiic obstruct! 1′(‘ pulmonary disease. Obstructive anti restrictive pulmonary diseases are usually grouped together under the heading of chrohic obstructive pulmonary disease (COPD). In the past the terms emphysema and bronchitis were used to describe clinical manifestations.
of COPD, but CO PO has been recognized to be a blend of pathologic pulmonary problems. COPD is usually caused by long-term exposure to pulmonary irritants! such as tobacco smoke, that cause metaplasia of pulmonary alrwav tissue. Airways are disrupted, lose their elastic properties, and become obstructed because of .mucosal edema, excessive secretions; and bronchospasm producing the clinical manifestations of COPD. Patients with COPD frequently become dyspneic during mild-tomoderate exertion. They have a chronic cough that produces
large amounts of thick secretions, frequent respiratory tract infections, and barrel-shaped chests, and they may purse their lips to breathe and have audible wheezing during breathing.

Bronchodilators, such as theophylline, are usually prescribed for patients with significant COPD) in  more.severe cases patients are given corticosteroids. Only in the most severe chronic cases is supplemental portable oxygen used .

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