Preoperative Pulmonary Assessment: A Review

Amit      Bahia; Srinivas      R. Bapoje

Abstract

Preoperative assessment of a patient for the development of perioperative pulmonary complications is an important step in the risk reduction strategy of a patient undergoing elective surgery. The incidence of perioperative pulmonary complications and its effect on patient morbidity, mortality, and costs associated with hospital stay is just as high as that of cardiac complications. A multitude of modifiable and non-modifiable patient and procedure related risk factors are associated with perioperative pulmonary complications. Few clinical interventions including lung expansion maneuvers such as incentive spirometry and continuous positive airway pressure have been proven to be effective in the prevention of perioperative pulmonary complications, although the evidence base is limited by the lack of well designed randomized controlled trials. Given the ramifications of perioperative pulmonary complications it is imperative that providers involved in the perioperative care of patients undergoing elective surgery be cognizant of risks and management strategies of such complications. Risk modifying interventions should be introduced where applicable and alternate therapies should be considered when such risks are insurmountable.

Keywords: Preoperative assessment, perioperative care, perioperative complications, elective surgery, cardiac complications, ramifications, Postoperative pulmonary complications (PPCs), bronchospasm, chronic obstructive pulmonary disease, elective thoracic, non-thoracic surgery, cardiothoracic surgeries, pre-anesthesia screening, bronchopulmonary disease, pneumonia, CABG surgery, postoperative supraventricular arrhythmias, Asthma, peak-flow rates, bariatric surgery, Obstructive Sleep Apnea (OSA), hyper-capnia, hypoxemia, pulmonary hypertension, Interstitial Lung Disease (ILD), pneumonectomy, cardiopulmonary exercise testing (CPET), Esophagectomy, adenocarcinoma, chest radiographs, Pulmonary Function Tests (PFTs), spirometry, blood urea nitrogen (BUN), heparin, thromboembolism, upper abdominal surgery, Continuous Positive Airway Pressure (CPAP), Lung function tests, chest x-rays