Perioperative Evaluation for the Respiratory System

Advances in surgery and anesthesia have increased the research for operable patients with comorbid diseases. Postoperative pulmonary complications increase mortality and morbidity, prolong hospital stay, increase the need for intensive care, and consequently increase health expenditures. There are three main purposes in preoperative evaluation: To determine the risk of preoperative complications, to reduce the risk of perioperative complications, and to eliminate the risk factors in the patient at risk of complications in the postoperative period. Correct preoperative evaluation will ensure that the patient is operated with the least risk. An overprotective approach may cause the patient not to have the operation that should be absolutely necessary or cause delays in the operation. Risk factors for postoperative pulmonary complications are patient-related and procedure-related risk factors. Patient-related risk factors are age, underlying airway disease (COPD/Asthma), smoking, general health status, sleep apnea, pulmonary hypertension, heart failure, and metabolic status. Depending on the situation, changes in respiratory functions may occur according to anesthesia and according to the type of surgery. Different situations cause different effects on respiratory physiology and can cause different respiratory complications. The most important postoperative pulmonary complications are atelectasis, infection, respiratory failure, and prolonged mechanical ventilation and exacerbation of underlying lung disease. Evaluation of the patient should focus on anamnesis and radiologic/laboratory investigation if needed. Taking the necessary precautions to make the preoperative patient suitable for anesthesia and taking measures to prevent postoperative pulmonary complications constitute risk-reduction strategies. Risk reduction strategies generally include smoking cessation, COPD/Asthma control, preoperative antibiotics/mucolytics (if needed), patient education, prophylaxis against thrombosis, pulmonary rehabilitation, and respiratory exercises.