PREVENTION OF RESPIRATORY COMPLICATIONS A FTER ABDOMINAL-SURGERY

Abdominal surgery, especially upper abdominal surgical procedures are known to adversely affect pulmonary function. Pulmonary complications are the most frequent cause of postoperative morbidity and mortality. This review article aimed to analyse the incidence and risk factors fo r postoperative pulmonary morbidity and their prevention. The most imp ortant means for preoperative assessment is the clinical examination; pulmonary function tests (spirometry) are not reliably predictive for postoperative pulmonary complications. Age, type of surgical procedure , smoking and nutritional state have all been identified as potential predictors for postoperative complications. However, usually there is not enough preoperative time available to obtain beneficial effects of stopping smoking and improvement of nutritional state. In patients wi th COPD, a preoperative multidisciplinary evaluation including the pri mary care physician, pulmonologist/intensivist, anesthesiologist and s urgeon is required. Consensus as to preoperative physiologic state, th erapeutic preparation, and postoperative management is essential. Simp le spirometry and arterial blood gas analysis are indicated in patient s exhibiting symptoms of obstructive airway disease. There are no valu es that contra-indicate an essential surgical procedure. Smoking shoul d stop at least 8 weeks preoperatively. Preoperative therapy for elect ive surgery with antibiotics, beta2-agonist, or anticholinergic bronch odilator aerosols, as well as training in cough and lung expansion tec hniques should begin at least 24 to 48 hours preoperatively. Postopera tive therapy should be continued for 3 to 5 days. Usually, anaesthesia is responsible tor early complications, whereas surgical procedures a re often associated with delayed morbidity. Laparoscopic procedures ar e recommended, as postoperative morbidity and hospital stay seem reduc ed in patients without COPD. Regional anaesthesia is given as having l ess adverse effects on pulmonary function than general anaesthesia. Ho wever, for unknown reasons these benefits are not associated with a de crease in postoperative respiratory complications. Moreover, the quali ty or the type of postoperative analgesia does not influence postopera tive respiratory morbidity. Postoperatively, oxygen administration inc reases SaO(2). but cannot abolish desaturation due to obstructive apne a. The various techniques of physiotherapy (chest physiotherapy, incen tive spirometry, continuous positive airway pressure breathing) seem t o be equivalent in efficacy; but intermittent positive pressure breath ing has no advantages, compared with the other treatments and could ev en be deleterious. Chest physiotherapy and incentive spirometry are th e most practical methods available for decreasing secretion contents o f airways, whereas continuous positive airway pressure breathing is ef ficient on atelectasis. in stage II or III COPD patients, admission in a intensive therapy unit and prolonged mechanical ventilation may be required.