AANA Journal course: update for nurse anesthetists--the preoperative pulmonary assessment: is this patient at high risk for surgery?

Postoperative pulmonary complications most often involve atelectasis followed by pneumonia and arterial hypoxemia. The severity of these complications is related to the decreases that occur in vital capacity and functional residual capacity. Astute anesthetists can prospectively identify patients and surgical procedures likely to be associated with pulmonary complications. Upper abdominal surgery carries a 30% to 40% pulmonary complication rate. Vertical laparotomies and lateral thoracotomies are associated with pulmonary risk, as are patients who are obese, emphysemic, asthmatic, or have cardiac disease. Optimal use of clinical data coupled with selective application of diagnostic tests, such as arterial blood gases and pulmonary function tests, help in the development of an appropriate anesthetic management plan that minimizes pulmonary risk, especially in patients with known pulmonary risk factors.