Answer:

The goal of preoperative preparation is to optimize the patient for surgery and to decrease the risk of postoperative pulmonary complications (PPCs). This patient’s risk factors for PPCs include preexisting pulmonary disease, cigarette smoking, abdominal surgery, and general anesthesia.

Preoperative strategies that have proven to reduce PPC rates include smoking cessation (see section B.12), optimizing airflow limitation in patients with obstructive lung disease (such as this patient), and treating respiratory tract infections, if present.

The severity of airflow limitations is assessed during preoperative evaluation and laboratory and diagnostic studies (see section B.1). Airflow limitation can be optimized by continuation of anti-inflammatory and bronchodilator therapy up to the time of surgery. Additional therapy, such as systemic corticosteroids may need to be initiated in patients with poorly controlled symptoms.

Elective surgery should not be performed in the presence of active respiratory infection and symptoms should be actively treated until the patient is back to baseline status.

Additionally, preoperative lung expansion maneuvers, such as deep breathing exercises, incentive spirometry, and chest physiotherapy are of proven benefit in reducing PPC rates.

• Hines RL, Marschall KE, eds. Stoelting’s Anesthesia and Co-existing Disease. 7th ed. Philadelphia, PA: Elsevier; 2018:15-32.
• Lakshminarasimhachar A, Smetana GW. Preoperative evaluation: estimation of pulmonary risk. Anesthesiol Clin. 2016;34:71-88.
• Woods BD, Sladen RN. Perioperative considerations for the patient with asthma and bronchospasm. Br J Anaesth. 2009;103(suppl 1):i57-i65.