This is the podcast, I see you round.

I'm an associate professor surgery, direct to the first of the band of our university school in Minnesota, Nashville, Tennessee.

I'm welcoming you back to the podcast.

It's been a rather busy summer here.

I have five kids, and so life has been happening here, which is keeping me away from the computer and doing podcast, but have been collecting some emails on some potential topics as well as ideas.

One of those ideas came up this past week in our intensive care unit when we admitted a woman who had rather severe lung disease, end-stage COPD with an inoperable lung cancer, home oxygen.

And as these things typically happen, the patient was smoking on her oxygen.

Sustained some burns to her face,

which were not surgical and were not life-thriving, but did develop a rather deep third-degree burn

to the lower extremities. And now we're faced with the prospect of having to operate on somebody

with severe lung disease to do an operation of the leg. And this brings up the whole idea is what are some of the perioperative evaluation of a person who has chronic lung disease?

What are the effects of anesthesia on somebody with preexisting lung disease or a lung condition?

And you need to be aware of these when you work in the intensive care unit or as you work as a surgeon

because you could take a patient who is reasonably marginal and basically cause them to decompensate

such that a patient like this who, for instance, isn't on chronic mechanical ventilation, you do a general anesthesia,

and they'll come back to the

intensive care unit on a ventilator, and they'll be difficult, if not impossible, to get off

the ventilator.

And then you're faced with a question of perhaps by care providers or the family of, well,

how was it that she was able to live without the ventilator before your surgery,

and then you did this operation, and now you can't get her off the ventilator?

What did you do wrong?

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