Preoperative Pulmonary Risk Assessment

Abstract

Postoperative pulmonary complications have a significant impact on perioperative morbidity and mortality and contribute substantially to health care costs. Surgical stress and anesthesia lead to changes in respiratory physiology, altering lung volumes, respiratory drive, and muscle function that can cumulatively increase the risk of postoperative pulmonary complications. Preoperative medical evaluation requires a structured approach to identify patient-, procedure-, and anesthesia-related risk factors for postoperative pulmonary complications. Validated risk prediction models can be used for risk stratification and to help tailor the preoperative investigation. Optimization of pulmonary comorbidities, smoking cessation, and correction of anemia are risk-mitigation strategies. Lung-protective ventilation, moderate PEEP application, and conservative use of neuromuscular blocking drugs are intra-operative preventive strategies. Postoperative early mobilization, chest physiotherapy, oral care, and appropriate analgesia speed up recovery. High-risk patients should receive inspiratory muscle training prior to surgery, and there should be a focus to minimize surgery time.

C‐Shaped Cartilage Development Using Wharton's Jelly‐Derived Hydrogels to Assemble a Highly Biomimetic Neotrachea for use in Circumferential Tracheal Reconstruction

“…Mucous elimination, a significant physiological function of the trachea, predominantly relies on airflow in the central airway. [ 8 ] Therefore, a reduction in the lumen area of neotracheas with C‐shaped cartilage rings can increase the airflow velocity, thereby increasing mucous transport. A study reported that most animal deaths occurred owing to mucoid impaction after reconstruction.…”

“…[ 4a,b ] However, mucous elimination predominantly relies on airflow in the central airway. [ 8 ] Therefore, neotracheas with combined CVCAS and C‐shaped cartilage rings, which retain the biomimetic structure and physiology, can improve tracheal repair by increasing the airflow velocity and mucous transport.…”

“…[ 7 ] The specific structure of C‐shaped cartilage rings and posterior smooth muscle in the native trachea ensures airflow and mucous transport through changes in airway diameter. [ 8 ] Some recent studies have attempted to simulate the physiological properties of the native trachea by regenerating C‐shaped cartilage rings with a dorsal muscle region; [ 9 ] however, segmental reconstruction of tracheal defects was not attempted in these studies. Therefore, it is unclear whether a highly biomimetic neotrachea with C‐shaped cartilage rings can improve CTDs repair.…”

Individualized risk estimation for postoperative pulmonary complications after hepatectomy based on perioperative variables

“…The extension of the operation duration has a great impact on postoperative respiration, digestion, physiological response, and the recovery of autonomic function, and affects the quality of postoperative rehabilitation. Additionally, the operation duration can affect the occurrence of PPCs[ 26 ]. A longer duration of surgery has a significant impact on postoperative respiratory function.…”

Role of Lung Recruitment Maneuvers in Elderly Post-operative Upper Abdominal Surgery

“…PPCs increase morbidity, lengthen hospital stays, and cause early mortality, all of which have a detrimental effect on postoperative recovery (14) . Contrarily, preoperative instruction in lung recruitment exercises gets elderly patients mentally and physically ready for the next procedure.…”