Perioperative Strategies in Preventing Postoperative Pulmonary Complications

Abstract

Postoperative respiratory complications represent the second most common postoperative complication after wound infection, with an estimated incidence ranging from 2.0% to 5.6% for surgical procedures. Respiratory failure after general anesthesia and tracheal extubation has been shown to be one of the most meaningful factors associated with poor patient outcomes, leading to longer hospital stays, higher costs, and increased 30 day mortality. Diseases that affect lung function cause one of two patterns of dysfunction obstructive and restrictive. Obstructive diseases include diseases characterized by a reduction in airflow and limitation including asthma, chronic bronchitis, chronic obstructive pulmonary disease (COPD) and emphysema. Restrictive lung diseases are characterized by reduced lung volumes, either because of an alteration in lung parenchyma or because of a disease of the pleura, chest wall, or neuromuscular apparatus. Current evidence suggests that risk factors for PPC are related to the patient health status, the particular anesthetic and surgical procedures chosen. Age, general co-morbidity, pre-existing respiratory and cardiac diseases, the use of general anesthesia and the overall surgical insult, are the most significant factors associated with complications.  Summary  90 General anesthesia results in an alteration in the mechanical properties of both the lung and the chest wall, leading to reductions in FRC. Anesthesia also results in an imbalance between the forces that expands the lung and that oppose expansion, leading to an altered intrapulmonary gas distribution, both with spontaneous and with mechanical ventilation. Changes in the lung mechanical properties seem to be secondary to those in the chest wall. Pulmonary complications following surgery may have significant morbidity and mortality, and can be associated with reintubation and an ICU stay. The most important complications are atelectasis, hypoxemia, pneumonia, pneumothorax, pulmonary edema and pulmonary embolism. There is Strategies to prevent postoperative pulmonary complications which includes preoperative, operative and postoperative. Preoperative strategies include treatment of any lung disease, chest physiotherapy, bronchodilators and stop smoking. Operative strategies, in general, a low tidal volume strategy is advised for all patients, and therapeutic strategies for preventing and treating atelectasis should be planned for those at higher risk. Postoperative strategies include analgesia, postoperative lung expansion, nasogastric tube and oxygen supply.  References  91 References