Perioperative Ventilation of the Vascular Surgery Patient

Abstract

Although cardiovascular disease represents the most com mon comorbidity in patients undergoing vascular surgery, perioperative ventilatory issues can also play a vital role in achieving good outcomes. Postoperative respiratory failure is uncommon after carotid endarterectomy or peripheral revascularization procedures, the risk of pulmonary compli cations following intra-abdominal or intrathoracic vascular surgery is high. In addition to primary lung diseases such as chronic obstructive pulmonary disease, associated organ dysfunction syndromes such as stroke, renal failure, and congestive heart failure can also contribute to respiratory morbidity. An approach to minimizing respiratory complica tions begins with a careful preoperative search for ways to maximize pulmonary function and establishment of targets for postoperative weaning. Intraoperative attention should be paid to intraoperative management of bronchospasm, auto-positive end-expiratory pressure, and acid-base status. Postoperative management should strive for rapid extuba tion, continuation of pharmacologic conditioning programs begun preoperatively, and consideration of the use of post operative regional analgesia for patients with severe lung disease.