patients at risk Respiratory complications of anaesthesia





Patients at risk Respiratory complications of anaesthesia:




1-diseas

COPD

Congestive heart failure



2-Obese



3-surgery type



Aortic aneurysm repair

Thoracic surgery

Abdominal surgery

Upper abdominal surgery

Neurosurgery

Head and neck surgery

Emergency surgery

Vascular surgery



Major intracranial surgery & Thoracic surgery > Upper abdominal surgery



Upper abdominal surgery > Lower abdominal surgery



Lower abdominal surgery > Limb surgery





4-Prolonged bed rest



5-Long surgery > 180 minutes





6-Elderly > 65 yearw



7-Smoking



8-ASA class ≥2




Recommendations of the American College of Physicians to reduce perioperative pulmonary complications in patients undergoing non-cardiothoracic surgery.




Recommendation 1:




• All patients undergoing non-cardiothoracic surgery should be evaluated for the presence of the following significant risk factors for postoperative pulmonary complications in order to receive pre- and postoperative interventions to reduce pulmonary risk:

chronic obstructive pulmonary disease, age older than 60 years, American Society of Anesthesiologists class of II or greater, functionally dependent, and congestive heart failure.



• The following are not significant risk factors for postoperative pulmonary complications: obesity and mild or moderate asthma.



Recommendation 2:




• Patients undergoing the following procedures are at higher risk for postoperative pulmonary complications and should be evaluated for other concomitant risk factors and receive pre- and postoperative interventions to reduce pulmonary complications:

prolonged surgery (>3 hours), abdominal surgery, thoracic surgery, neurosurgery, head and neck surgery, vascular surgery, aortic aneurysm repair, emergency surgery, and general anesthesia.



Recommendation 3:




• A low serum albumin level (<35 g/L) is a powerful marker of increased risk for postoperative pulmonary complications and should be measured in all patients who are clinically suspected of having hypoalbuminemia; measurement should be considered in patients with one or more risk factors for perioperative pulmonary complications.



Recommendation 4:




• All patients who after preoperative evaluation are found to be at higher risk for postoperative pulmonary complications should receive the following postoperative procedures in order to reduce postoperative pulmonary complications:

deep breathing exercises or incentive spirometry and the selective use of a nasogastric tube (as needed for postoperative nausea or vomiting, inability to tolerate oral intake, or symptomatic abdominal distention).



Recommendation 5:




• Preoperative spirometry and chest radiography should not be used routinely for predicting risk for postoperative pulmonary complications.

• Preoperative pulmonary function testing or chest radiography may be appropriate in patients with a previous diagnosis of chronic obstructive pulmonary disease or asthma.



Recommendation 6:




• The following procedures should not be used solely for reducing postoperative pulmonary complication risk:

right heart catheterization and total parenteral nutrition or total enteral nutrition (for patients who are malnourished or have low serum albumin levels).