المصدر: Risk of post-operative pulmonary complications في منتدى : كتب طبية ---------------------------------------------------------- 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).
