High risk patients:
(1) cigarette smoking
(2) poor general health status; ASA class > II
(3) age > 70 years
(4) obesity
(5) COPD or asthma
Preoperative interventions:
(1) Encourage cigarette smoking cessation for at least 8 weeks prior to surgery.
(2) Treat airflow obstruction in patients with asthma or chronic obstructive pulmonary disease.
(3) Delay surgery if possible if a respiratory infection is present. Treat with antibiotics if indicated.
(4) In high risk patients begin patient education on post-operative lung expansion maneuvers.
Perioperative interventions:
(1) Try to limit the duration of surgery to < 3 hours.
(2) Use spinal or epidural anaesthesia if possible.
(3) Avoid use of pancuronium.
(4) Use laparoscopic techniques when possible.
(5) If the procedure is to involve the thorax or upper abdomen, try to use the simplest and least ambitious procedure possible.
Postoperative interventions:
(1) Use a lung expansion maneuver (deep breathing exercise; incentive spirometry; continuous positive airway pressure).
(2) Use epidural analgesia and/or intercostal nerve blocks when possible,
Additional interventions that might help:
(1) If obese and deconditioned, initiate an exercise program several weeks prior to surgery.
(2) Immunodeficiencies and immunosuppressive therapy can increase the risk for infections and may affect wound healing.
