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Chandler D, Mosieri C, Kallurkar A, Pham AD, Okada LK, Kaye RJ, Cornett EM, Fox CJ, Urman RD, Kaye AD. Perioperative strategies for the reduction of postoperative pulmonary complications. Best Pract Res Clin Anaesthesiol 2020; 34:153-166. [PMID: 32711826 DOI: 10.1016/j.bpa.2020.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 01/01/2023]
Abstract
Postoperative pulmonary complications (PPCs), estimated between 2.0% and 5.6% in the general surgical population and 20-70% for upper abdominal and thoracic surgeries, are a significant factor leading to poor patient outcomes. Efforts to decrease the incidence of PPCs such as bronchospasm, atelectasis, exacerbations of underlying chronic lung conditions, infections (bronchitis and pneumonia), prolonged mechanical ventilation, and respiratory failure, begins with a detailed preoperative risk evaluation. There are several available preoperative tests to estimate the risk of PPCs. However, the value of some of these studies to estimate PPCs remains controversial and is still debated. In this review, the preoperative risk assessment of PPCs is examined along with preoperative pulmonary tests to estimate risk, intraoperative, and procedure-associated risk factors for PPCs, and perioperative strategies to decrease PPCs. The importance of minimizing these events is reflected in the fact that nearly 25% of postoperative deaths occurring in the first week after surgery are associated with PPCs. This review provides important information to help clinical anesthesiologists to recognize potential risks for pulmonary complications and allows strategies to create an appropriate perioperative plan for patients.
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Affiliation(s)
- Debbie Chandler
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
| | - Chizoba Mosieri
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
| | - Anusha Kallurkar
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
| | - Alex D Pham
- Department of Anesthesiology, LSU Health New Orleans, 1542 Tulane Ave, New Orleans LA 70112, USA.
| | - Lindsey K Okada
- Tulane University School of Medicine, 1430 Tulane Ave., New Orleans, LA, 70112, USA.
| | - Rachel J Kaye
- Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
| | - Charles J Fox
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
| | - Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA; Vice Chancellor of Academic Affairs, LSU Health Shreveport, 1501 Kings Highway, Shreveport LA 71103, USA.
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Wald K, Letourneau J, Eshima-McKay R, Monks J, Mok-Lin E, Cedars M, Rosen M. Ovarian stimulation and egg retrieval in the acutely ill patient: special considerations. J Assist Reprod Genet 2019; 36:2087-2094. [PMID: 31396851 DOI: 10.1007/s10815-019-01556-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/02/2019] [Indexed: 01/28/2023] Open
Affiliation(s)
- Kaitlyn Wald
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA.
| | - Joseph Letourneau
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA.,University of Utah Center for Reproductive Medicine, Salt Lake City, UT, USA
| | - Rachel Eshima-McKay
- Department of Anesthesia, University of California, San Francisco, San Francisco, CA, USA
| | - John Monks
- Department of Anesthesia, University of California, San Francisco, San Francisco, CA, USA
| | - Evelyn Mok-Lin
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
| | - Marcelle Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
| | - Mitchell Rosen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 499 Illinois Street, 6th Floor, San Francisco, CA, 94158, USA
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