Patients at risk Respiratory complications of anaesthesia

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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​


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



Recommendation 1:​

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• 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:​

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• 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:​

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• 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:​

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• 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:​

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• 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:​

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• 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).​
 



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