Patients at risk Respiratory complications of anaesthesia:
Congestive heart failure
Aortic aneurysm repair
Upper abdominal surgery
Head and neck 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
8-ASA class ≥2
Recommendations of the American College of Physicians to reduce perioperative pulmonary complications in patients undergoing non-cardiothoracic surgery.
• 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.
• 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.
• 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.
• 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).
• 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.
• 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).