Perioperative Treatment in Pulmonary Disease

The goals of preoperative treatment are to improve the aspects of disease that may be reversible.

1. Cessation of smoking for 12 hours before surgery may reduce nicotine and carboxyhemoglobin levels, promoting better tissue oxygen transport. Cessation of smoking for longer periods (at least several weeks) does reduce the risk of wound infection and may reduce the risk of POPCs by improving ciliary function and reducing airway secretions and irritability.
2. Those with acute exacerbations of COPD or asthma should be treated and elective procedures delayed until resolution. Unfortunately, there are no data on how long after resolution that the patient remains at increased risk.
3. Identification of the patient with sleep apnea and institution of and optimization of continuous airway pressure/bilevel positive airway pressure (CPAP/BIPAP) preoperatively may be associated with improved outcomes.
4. Measures aimed at preventing perioperative thromboembolism (such as compression stockings or anticoagulants) are important for all major surgeries. These may be instituted, preoperatively, intraoperatively, or postoperatively.
5. Lung expansion maneuvers (voluntary deep breathing, coughing, incentive spirometry, and chest percussion and vibration combined with postural drainage) improve mobilization of secretions and increase lung volumes, reducing the incidence of POPCs. Training in these methods preoperatively should ideally be done to optimize postoperative outcome.