Procedure related risk factors for postop pulmonary complications
•Download as PPTX, PDF•
1 like•694 views
Factors related to the type and duration of surgery that increase postoperative pulmonary complications are reviewed in these slides
Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (11)
Similar to Procedure related risk factors for postop pulmonary complications
Similar to Procedure related risk factors for postop pulmonary complications (20)
More from Terry Shaneyfelt
More from Terry Shaneyfelt (18)
Recently uploaded
Recently uploaded (20)
Procedure related risk factors for postop pulmonary complications
- 1. Procedure-Related Risk Factors for Postoperative Pulmonary Complications Terry Shaneyfelt, MD, MPH Associate Professor, UAB Department of Medicine
- 2. • Adults undergoing noncardiothoracic surgery • ACP Guidelines on risk assessment for and strategies to reduce perioperative pulmonary complications have not been updated since 2006 (Ann Intern Med 2006;144:575) Disclaimer
- 3. Pulmonary Risk Assessment • Goals: 1. Assess patient-related pulmonary risk factors 2. Assess procedure-related risk factors 3. Reduce risk (if possible) • 3 components: • History • Physical exam • Testing
- 4. • Atelectasis • Pneumonia • Prolonged mechanical ventilation and respiratory failure • Exacerbation of underlying lung disease • Bronchospasm Significant Pulmonary Complications
- 5. • Respiratory effects of general anesthesia • Decreased respiratory drive with diminished response to both hypercapnea and hypoxia • Drugs (neuromuscular blockers and anesthetic agents) cause diaphragm and chest wall relaxation (dysfunction) • Reduced lung volumes • Vital capacity reduced 50-60% • Functional residual capacity reduced by 30% Perioperative Pulmonary Physiology Atelectasis & V/Q mismatch
- 6. • Inhibition of cough and impaired mucociliary clearance • Narcotics & anesthesia Perioperative Pulmonary Physiology Pneumonia
- 7. • Surgical site #1 risk factor • Aortic (OR 6.90) • Thoracic (OR 4.24) • Upper abdomen (OR 2.96) • Neurosurgical (OR 2.53) • ENT (OR 2.21) • Emergency surgery (OR 2.52) • Laparoscopic probably has less risk • Duration of surgery > 3-4 hrs (OR 2.14) • General anesthesia (OR 2.35) • Long acting neuromuscular blockers (pancuronium) Procedure-Related Risk factors for postop pulmonary complications
Editor's Notes
- In this PowerPoint presentation I review procedure-related risk factors for postoperative pulmonary complications.
- This presentation is focused on adults undergoing noncardiothoracic surgery. The “current” pulmonary preop guidelines are somewhat out of date as sleep apnea and pulmonary hypertension are emerging risk factors that are not adequately addressed. It is unknown when an update of the guideline will occur.
- Pulmonary risk assessment in the preop clinic has 2 goals: 1) to assess patient and procedure-related risk and 2) to reduce that risk as much as possible. The history and PE are the cornerstones of pulmonary risk assessment. Testing has a very limited role (see PowerPoints on this topic). The evaluation should focus on identifying identified risk factors and determining if the patient’s underlying pulmonary disease is optimally controlled.
- This slide shows the clinically important perioperative pulmonary complications. Risk prediction tools only exist for respiratory failure and pneumonia.
- Postoperative pulmonary complications are an extension of normal perioperative pulmonary physiology. General anesthesia and opioids decrease respiratory drive. Anesthetics and neuromuscular blocking agents result in diaphragmatic and chest wall dysfunction. This all leads to reduced lung volumes, both vital capacity (which is the volume of air in the lungs after maximal inhalation to maximal exhalation or total lung capacity minus residual volume) and functional residual capacity (volume of air left in the lungs after a normal exhalation). This then leads to atelectasis as FRC drops below closing capacity or closing volume.
- Cough and mucociliary clearance are impaired by narcotics and anesthesia which can result in pneumonia.
- This slide shows procedure-related risk factors that have been shown to be significantly associated with postoperative pulmonary complications. The list is ordered from most important to least important causes of postoperative pulmonary complications. By far the most important risk factor for postoperative pulmonary complications is surgical site. It is a greater risk factor than any patient-related risk factor. The closer to the diaphragm and within the chest the greater the risk. Certain procedures convey very high risk even in otherwise healthy, low risk patients. Laparoscopic surgery leads to less postoperative pain and less reduction in lung volumes and thus is probably less risky but the data is less well established. The need for emergency surgery increases postop pulmonary complication rates. Duration of surgery is an important predictor, with prolonged surgery increasing risk. General anesthesia confers greater risk than regional nerve blocks. Long acting neuromuscular blocking agents increase risk.