RT Book, Section A1 Onigkeit, James A. A1 Warner, David O. A2 Longnecker, David E. A2 Brown, David L. A2 Newman, Mark F. A2 Zapol, Warren M. SR Print(0) ID 56623009 T1 Chapter 11. Evaluation of the Patient with Pulmonary Disease T2 Anesthesiology, 2e YR 2012 FD 2012 PB The McGraw-Hill Companies PP New York, NY SN 978-0-07-178513-6 LK accessanesthesiology.mhmedical.com/content.aspx?aid=56623009 RD 2024/03/29 AB Postoperative pulmonary complications are a significant source of morbidity, mortality, and excess costs in modern anesthesia practice.Pulmonary disease is the predominant patient-related risk factor for postoperative pulmonary complications, with other factors including age, general health status, and cigarette smoking. The predominant procedural risk factor is the site of surgery, with thoracic and upper abdominal surgery associated with the highest risk.Routine screening or other testing for pulmonary function is not indicated. Rather, testing should be used to make an initial diagnosis in a patient with previously undiagnosed pulmonary disease, to monitor the status of patients with respiratory disease, or to assist with postoperative management.Once pulmonary disease has been identified, it should be optimally treated before surgery. For example, patients with reactive airway disease may require adjustment of bronchodilator and corticosteroid therapy if their airway reactivity is not under optimal control.The perioperative period is an excellent opportunity to provide tobacco interventions in patients who smoke cigarettes.Useful intraoperative techniques to decrease the incidence of postoperative pulmonary complications include prophylaxis to minimize bronchospasm, rational use of neuromuscular blocking agents, and limiting tidal volumes during mechanical ventilation.Postoperatively, therapies that promote lung expansion may reduce the risk of pulmonary complications.