[Regional or general anesthesia in patients with pulmonary risks?].

Such partial functions of the respiratory system as ventilation, gas exchange, bronchomotor tone, respiratory regulation, secretion within the airways, mucociliary clearance, etc., are less impaired by such procedures as peridural or spinal anaesthesia than by general anaesthesia. As a result, it is often concluded that regional anaesthesia should always be used preferentially in the case of patients with a pulmonary risk. However, comparative studies have shown that pulmonary morbidity and mortality are little influenced by the anesthetic procedure. For, in the first instance, the incidence of post-operative complications affecting respiration are determined by previous lung pathologies, the age of the patient, and the location and duration of the surgical procedure. These are factors that cannot readily be influenced by anaesthesiological measures. For this reason, the pre-operative diagnostic evaluation and preparation, post-operative prophylaxis and treatment, including the components pain elimination, physiotherapy, respiratory therapy, broncholysis and secretolysis, are more important than the anaesthetic procedure itself.