Preoperative Pulmonary Evaluation Research Articles

Preoperative Evaluation of the Patient With Pulmonary Disease

Preoperative pulmonary evaluation is important in the management of patients with lung disease who are undergoing elective cardiothoracic or noncardiothoracic surgery. In some instances, preoperative pulmonary evaluations may also contribute to the management of patients being considered for urgent surgery. The incidence of postoperative pulmonary complications (PPCs) is high and is associated with substantial morbidity and mortality, and prolonged hospital stays. Perioperative pulmonary complications in patients undergoing elective noncardiothoracic surgery can be more accurately predicted than in patients undergoing elective cardiothoracic surgery. Effective strategies to prevent complications in the postoperative period are few. Incentive spirometry and continuous positive airway pressure are the only modalities of proven benefit. Identifying patients who are at risk for the development of PPCs and managing their underlying modifiable risk factors aggressively prior to surgery is essential.

Correlation between preoperative pulmonary function,method of surgical approach with postoperative time of tracheal extubation in patients with scoliosis

To evaluate the correlation between preoperative pulmonary function tests, surgical approach and postoperative time of tracheal extubation in patients with scoliosis. The case records of 115 patients, who underwent anterior or posterior fusion, were reviewed. And we studied the relative factors on postoperative time of tracheal extubation by multiple linear regression analysis. Multiple linear regression showed that the time of tracheal extubation had negative correlation with the VC%, MVV%, FEV1%, FEF25% and thoracoplasty. On the other hand, the time of extubation in patients with thoracoplasty was larger than those without thoracoplasty, but the time of extubation in patients with or without thoracotomy had no statistical significance. VC%, MVV%, FEV1%, FEF25% and thoracoplasty are the main determinants of the time of extubation in patients with scoliosis. Preoperative pulmonary function evaluation and surgical approach selection may play an important role in determining the time of tracheal extubation in patients with scoliosis.

Update in Perioperative Medicine

intraoperative OR postoperative OR perioperative AND complication OR event. We excluded articles related to transplantation, cardiac, and pediatric surgery. We ran this search monthly during the eligible period and selected studies that were methodologically sound, were of interest to practicing internists, addressed common and morbid postoperative outcomes, and could potentially change the approach to diagnosis, risk stratification, or prevention of postoperative medical complications. Each author inde- pendently generated a list of articles for potential inclusion; we determined the final list by consensus. We consider here 5 broad topic areas: cardiac risk stratification and risk reduction strategies, preoperative pulmonary evaluation, venous thromboembolism prophy- laxis, diabetes mellitus, and postoperative delirium.

Preoperative pulmonary evaluation: identifying and reducing risks for pulmonary complications.

Postoperative pulmonary complications are among the most common sources of morbidity in patients undergoing major surgery. For this reason, the preoperative patient evaluation should emphasize risk factors for pulmonary complications as well as for traditional cardiac complications, as the former are comparably frequent and associated with longer hospital stays. Procedure-related risk factors are more important than patient-related risk factors for predicting pulmonary events, but clinicians should assess both types of factors. Pulmonary function testing has a limited role and should not be the basis for denying surgery if the surgical indication is compelling. Strategies to reduce the risk of postoperative pulmonary complications include optimizing management of chronic lung disease before surgery, lung expansion maneuvers, pain control, and selective placement of nasogastric tubes.

Preoperative pulmonary evaluation of surgical patients using the vitalograph

Abstract A prospective study of 100 patients was undertaken in order to assess whether or not, in apparently normal clinical subjects undergoing surgery, postoperative pulmonary complications could be predicted by the use of simple preoperative pulmonary function tests obtained by the use of the vitalograph. We have found, using a multiple statistical regression technique, that the addition of the vitalograph significantly increases the ability to predict postoperative pulmonary complications.

Pulmonary function tests in preoperative pulmonary evaluation

Pulmonary function testing (PFT) has been used to evaluate the risk for postoperative complications since the 1950s. PFT including spirometry, lung volumes, diffusing capacity, oximetry, and arterial blood gases has been used to assess the postoperative risk of lung resection. In selected cases, additional evaluation may include radionuclide lung scanning, exercise testing, invasive pulmonary hemodynamic measurements, and risk stratification analysis. A new index, predicted postoperative product (PPP), was found to have strong predictive ability for mortality. We defined a new useful index, measured product (MP), to predict postoperative complications; MP had similar advantages of PPP. Since diffusing capacity at rest has been shown to be a good predictor of postoperative complications following lung resection, and since exercise testing has been also useful in preoperative evaluation prior to lung resection, we reasoned that evaluation of the effect of exercise on diffusing capacity would be helpful to evaluate the ability of the pulmonary capillary bed to expand and increase its capacity to transfer gas during exercise.

Preoperative pulmonary evaluation: facts and myths

This review summarizes recent reports on preoperative pulmonary evaluation focusing on the impact on outcome in thoracic and non-thoracic surgery. Data suggest that hitherto widely accepted pulmonary function tests do not predict perioperative complications. Therefore, they may not be considered alone to decide on the patient's operability. So-called prohibitive lung function parameters should no longer be used to deny a potentially curative lung resection. A more clinically oriented, interdisciplinary approach to severely compromised patients may be best suited to discuss and solve their problems.

Assessing and Modifying the Risk of Postoperative Pulmonary Complications

Preoperative pulmonary evaluation and preparation involve first identifying patients at risk for complications and then attempting to modify that risk. For most patients without underlying lung disease, a thorough history and physical examination and preoperative instruction in the use of incentive spirometry is sufficient. In patients with known or suspected lung disease, preoperative pulmonary function tests, while unproven as prognostic tools, may reduce risk by aiding in medical management, and in the case of the lung resection candidate, by helping determine very directly his or her viability for the procedure.

Preoperative Prediction of Postoperative Respiratory Outcome: Coronary Artery Bypass Grafting

The hypothesis that traditionally defined preoperative risk factors predict prolonged mechanical ventilation after coronary artery bypass graft surgery (CABG) was tested in our cohort. The predictive power of these factors was quantified, and specific patient subsets destined for prolonged mechanical ventilation after CABG surgery were defined. Five hundred thirteen consecutive patients undergoing CABG were prospectively evaluated. Preoperative pulmonary evaluation included clinical historic data, standard spirometry, and arterial blood gas. Preoperative cardiac parameters included clinical parameters and left ventricular function assessment. Nonthoracic organ (renal, endocrine, pancreas, liver) function was assessed. University-based, tertiary referral center. None (observational only). Duration of mechanical ventilation, duration of surgical ICU stay, and mortality. Multivariate regression analyses revealed that for the patient undergoing routine elective surgery and the patient undergoing urgent surgery, prolonged mechanical ventilation and death were rare events (8.3% and 2.0%, respectively). The combination of reduced left ventricular ejection fraction and the presence of selected preexisting comorbid conditions (clinical congestive heart failure, angina, current smoking, diabetes) served as modest risk factors for prolonged mechanical ventilation; their absence strongly predicted an uncomplicated postoperative respiratory course. No pulmonary diagnosis, mechanical lung function, or blood gas parameter substantially contributed to predicting adverse outcome. Classification and regression tree subgroup analysis refined specific factors important in specific subgroups. With the exception of left ventricular ejection fraction, no preoperative factors emerge as good predictors across all subgroups. This series suggests that pulmonary diagnosis, lung mechanics, and blood gas parameters do not offer the clinician global rules in predicting postoperative respiratory outcome, nor should they be used as exclusion crteria for CABG surgery.

PULMONARY COMPLICATIONS OF LIVER TRANSPLANTATION

The preoperative pulmonary evaluation of organ transplant candidates involves the diagnosis of unexplained pulmonary infiltrates or symptoms, interpretation of pulmonary function abnormalities, and an assessment of surgical risk. Pretransplant pulmonary considerations in patients with end-stage hepatic diseases relate primarily to hypoxemia from poorly understood intrapulmonary vascular dilatations, mechanical dysfunction, and states of increased extravascular lung water. Except in severe cases, however, these generally do not prohibit liver transplantation, and even are likely to improve after transplant surgery. Early postoperative complications may be categorized as those expected from extensive intra-abdominal surgery that requires significant volume resuscitation, which typically are managed in the usual manner for those clinical situations. As immunosuppression begins to have an effect, the LTx recipient becomes susceptible to the same opportunistic infectious organisms (with their frequent pulmonary involvement) that cause significant morbidity and mortality in recipients of other solid organ transplants. Because many of the immunosuppressive agents also are the same, noninfectious side effects such as pulmonary edema and malignancy also are similar. As with all immunocompromised patients, prophylaxis, when possible, persistent infection surveillance, and an aggressive diagnostic and therapeutic approach help decrease the impact of pulmonary dysfunction in LTx recipients.

Southwestern Internal Medicine Conference: Preoperative Pulmonary Evaluation

The purpose of preoperative pulmonary assessment is to predict which patients are at greater risk of pulmonary complications, under which circumstances such complications may occur, and whether surgery should be denied based on that risk. In this article, the author addresses the following major issues in preoperative pulmonary assessment: 1) the risk of pulmonary complications in relation to the type of surgical procedure; 2) the value of preoperative pulmonary function testing, including when such testing should be performed and how the results should be used; and 3) guidelines for assessment of those patients about to undergo resectional surgery of the lung.

Preoperative Pulmonary Functional Evaluation for Thoracic and Cardiothoracic Surgery

Preoperative Pulmonary Functional Evaluation for Thoracic and Cardiothoracic Surgery

Preoperative pulmonary function evaluation for laparoscopic cholecystectomy.

Hypercarbia with respiratory acidosis is a recognized complication of laparoscopic cholecystectomy. This study was performed to identify preoperatively those patients who may develop hypercarbia and acidosis during the procedure. Retrospective analysis of preoperative variables. Thirty-one consecutive patients underwent laparoscopic cholecystectomy at one institution who were receiving both preoperative pulmonary function tests and arterial blood gas analysis. More than 80 demographic, laboratory, and perioperative variables were entered into a univariate analysis to identify predictors of intraoperative acidosis (pH, < 7.35). Patient age, duration of the procedure, and preoperative blood gas values were not predictors of intraoperative acidosis. Several univariant predictors for patients experiencing carbon dioxide pneumoperitoneum-induced hypercarbia were identified; these included an elevated American Society of Anesthesiologists classification and significant decreases in forced expiratory flow at 25% of maximum, maximal forced expiratory flow, maximal voluntary ventilation, vital capacity, inspiratory capacity, and diffusing capacity of the lung for carbon monoxide. This study suggests that neither age nor preoperative arterial blood gas values are predictive of intraoperative hypercarbia and acidosis during periods of carbon dioxide pneumoperitoneum. However, preoperative pulmonary function measures of decreased flow, limited capacity, and compromised diffusion do correspond to the development of intraoperative acidosis. Preoperative evaluation with pulmonary function tests demonstrating forced expiratory volumes less than 70% of predicted values and diffusion defects less than 80% of predicted values can identify those patients who are at risk of developing hypercarbia and acidosis.

Anesthetic Choice for the Asthmatic Patient

To the Editor . —As an anesthesiologist and an internist I must comment in regard to the recent article on preoperative pulmonary evaluation. 1 An otherwise satisfactory review was marred by the discussion of anesthetic choice for the asthmatic patient. An obvious lack of familiarity with current anesthetic practice and literature was evidenced and several misconceptions were reinforced. In regard to the inhalational agent of choice there is mounting evidence that the inhalational agents in routine use today (isoflurane, enflurane, halothane) are essentially equivalent in their bronchodilating actions. 2,3 In some settings the newer agents may be superior to halothane. 2,4 Cyclopropane, an inhalational agent we were cautioned against using, 1 has not been available for years. Like diethyl ether its explosive properties mandated its removal from the operating room environment. d-Tubocurarine, though still used in the practice of anesthesia, is rarely, if ever, administered in doses that could induce or

Preoperative Identification and Evaluation of the Patient with Lung Disease

Preoperative pulmonary function evaluation begins with the bedside, clinical identification of the presence of significant lung disease. Once a patient is so identified, preoperative pulmonary-function studies are indicated. The optimal screening studies for most patients are spirometry and arterial blood gas analysis. Patients who are identified as having marginal function by screening techniques should be studied further by more specialized studies, including radioisotopic evaluation of regional lung function. If a patient is identified as an operative candidate, but one who has increased risk of postoperative morbidity, prophylactic measures should be instituted to reduce postoperative complications. The essence of such measures is increased care preoperatively, intraoperatively, and postoperatively. The use of preoperative evaluation of pulmonary function presents a different magnitude of problem in defining the risk of morbidity in contrast to that of mortality. Available data provide a firm basis for the identification of the patient at increased risk of morbidity. After 23 years and dozens of spirometric studies involving thousands of patients, it is apparent that there is no spirometric number, percentage, or category that will absolutely separate the operable from the inoperable patient. There are estimates of risk--guidelines, to be sure--but no absolutes. The patient whose lung function would have been considered to prohibit lung resection in the 1950s has been successfully operated on in the 1980s. In dealing with the risk of mortality, the physician should always bear in mind that, although statistics apply to groups, they often do not apply to individual patients.

Medical consultation on surgical services: an annotated bibliography.

This bibliography provides a literature base for residents on medical consultation services and for internists performing consultations in a field that is difficult to research through Index Medicus.

Preoperative Pulmonary Evaluation of the Dyspneic Surgical Candidate

Current methods of anesthesia and intensive postoperative care allow major operations to be performed in the presence of significant pulmonary impairment. For predicting pulmonary ability to tolerate surgery, the most important ventilatory tests are measures of maximum air flow.

Preoperative pulmonary evaluation and therapy for surgery patients

Preoperative pulmonary evaluation and therapy for surgery patients

Preoperative Pulmonary Evaluation and Therapy for Surgery Patients

Simple pulmonary function studies can be utilized successfully for diagnosis of pulmonary problems in surgery patients preoperatively. In the present study, randomly selected patients were treated preoperatively and postoperatively with cessation of smoking, bronchodilator drugs, antibiotics, inhalation of humidified gases, segmental postural drainage, and chest physiotherapy. When compared to nontreated poor risk patients, the treated patients had a marked reduction in postoperative morbidity and mortality due to pulmonary complications. Although the frequency and the severity of pulmonary complications were somewhat greater in the treated patients than in a group of good patients who were considerably younger in age, the differences were not significant. Extension of these simple therapeutic measures to large numbers of poor risk patients should reduce postoperative morbidity and mortality, allow earlier discharge, and lower the costs of patient care.

THE MATCH TEST AS AN AID TO PREOPERATIVE PULMONARY EVALUATION.

THE MATCH TEST AS AN AID TO PREOPERATIVE PULMONARY EVALUATION.