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Pulmonary Complications and Preoperative Pulmonary Evaluation

Posted Aug 12 2008 7:08pm


More pulmonary than cardiovascular complications

In general, any surgery imposes a risk to every system in our body. Most of the complications of surgery are related to cardiovascular events as well as infections. However Pulmonary complications after surgery are also frequent and probably more than the cardiovascular.

Which after-surgery complications in the lungs?

Typical pulmonary complications are local infections like pneumonia, disordered gas exchange with respiratory failure, bronchospasm (wit symptoms of asthma), marginal collapse of portions of the lungs (also called atelectasis), and/or exacerbations of previously existing pulmonary conditions (e.g. exacerbation of COPD).

What predisposes to pulmonary complications?

The nature of the pulmonary complications can be related to the surgical procedure itself or to the patient. The surgical procedure may be described according to site, duration, and anesthesia from which it may be expected that procedures close to the thorax, prolonged interventions, and general anesthesia are associated with subsequent pulmonary complications.

However, patients may also predispose to some risk of complications in the pulmonary structure and functions. Patients with chronic lung diseases tend to have more complications, especially patients with COPD. Age >60 years old, smoking condition, deficient health condition, and heart failure are potential elements of risk for pulmonary complications.

How a physician gather facts over issues to solve

These facts make it necessary to assess patients in plan of surgery for potential lung localized detrimental events. The interview of a patient under surgery program must include questions related to previous lung diseases, isolated respiratory symptoms, and smoking status. The physical examination must also be directed to find anomalies of the pulmonary area as well as trachea at the neck.

The laboratory studies of patients with positive findings in history of physical exam will mandate assessing with one or several of: pulmonary function tests (spirometry), arterial blood gas analysis, chest X-rays, and serum albumin.

Recommendations to the patient

After consideration of risk, patients would be able to receive instructions like: smoking cessation, COPD optimization of therapy, and some recommendations after surgery: lung expansion maneuvers, appropriate analgesia and prophylaxis of deep venous thrombosis. For some patients it may be required other methods of lung ventilation and controlled use of nasogastric tubes (indicating them just when really necessary and not as routine).

In summary

Patients are susceptible of lung complications when they go through a surgical procedure and an appropriate approach may minimize the occurrence of those complications.

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