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 presence of infection and the effect of
anaesthesia with accumulation of secretion will 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 .