Perioperative respiratory complications: current evidence and strategy discussed in 2017 JA symposium

Abstract

Respiratory management during general anesthesia aims to safely secure the airway and maintain adequate ventilation to deliver oxygen to the vital organs, maintaining homeostasis even during surgery. Despite its clinical importance, anesthesiologists often encounter difficulties in properly managing respiration during the perioperative period, leading to severe respiratory complications. In this year's JA symposium, 5 editorial board members of Journal of Anesthesia (JA) who are experts in the field of respiratory management in anesthesia discussed the following topics: quitting smoking before surgery: exposure to passive smoke is damaging to children, ventilator-associated pneumonia, high inspiratory oxygen concentration and lung injury, aspiration pneumonia, and postoperative respiratory management strategy in patients with obstructive sleep apnea. We hope that this special article regarding this year's JA symposium may be useful for JA readers to manage clinical anesthesia on a daily basis.

Influence of bilateral nasal packing on sleep oxygen saturation after general anesthesia: A prospective cohort study

“…Regli et al found that non-OSAS patients were more likely to have increased sleep hypoxemia with nasal packing after general anesthesia ( 19 ). The clinical implication is that although OSAS is an independent predictor of increased risks of complications after general anesthesia ( 11 , 20 – 22 ), patients with non-OSAS should also be paid attention after bilateral nasal packing because of the high possibility of great deterioration of sleep hypoxemia after general anesthesia. Patients with high modified Mallampati grades are more likely to have glossopharyngeal collapse during sleep ( 6 ).…”

Preoperative vaping prevalence and behavior of French surgical patients: A multicentre study

“…In addition, few or no recommendations were suggested to the patient. This point should be discussed in the future regarding the potential risks of these devices and the need for professionals to inform their patients 14-16 .…”

“…When used for smoking cessation, a recent Cochrane review pointed out that e-cigarettes may help to stop smoking without any serious side effects 12 . However, their role and effectiveness in managing smoking cessation is unclear and continues to divide the scientific community 13-16 . In 2016, the Food and Drug Administration (FDA) of the USA regulated a rule to cover all tobacco products, including ENDS.…”

“…Unfortunately, published case reports of severe or even fatal respiratory complications have highlighted the dangers of inhaling aerosolised substances among persons who have reported use of e-cigarettes 14,15 . For the perioperative period, no data or recommendations on the use of e-cigarettes have been published, although the dangers of tobacco on airway irritation (bronchospasm, laryngospasm) and postoperative mortality are well known 16,17 . Concerning the preoperative period, no data about vaping the day of surgery and its potential consequences have been reported, in contrast to smoking 16 .…”

“…For the perioperative period, no data or recommendations on the use of e-cigarettes have been published, although the dangers of tobacco on airway irritation (bronchospasm, laryngospasm) and postoperative mortality are well known 16,17 . Concerning the preoperative period, no data about vaping the day of surgery and its potential consequences have been reported, in contrast to smoking 16 .…”